RadPartners’ Partners are not Partners

I posted two tweets the other day that deserve some further discussion:

I’ve since by told by another source at RP that this is actually the third quarter in a row that profit-sharing has been delayed.

These “unique” payments are the ubiquitous practice of a group putting money in your 401k. “Profit sharing” is just the actual term used by the IRS. Practically, these contributions are just a portion of your compensation that is tax-deferred. For reference, my group contributes to my 401k on a monthly basis.

Now, I am obviously not privy to RP’s internal workings, but I suspect these delays are twofold.

One, RP is suffering from cashflow/liquidity issues. That’s what they essentially say in the email snippet I’ve shared above.

Two, businesses have an incentive to delay payments/hold onto cash thanks to the time value of money: having money now instead of later is itself worth money–because you can invest it. By holding onto their radiologists’ money for longer, they can keep these funds earning interest, which helps their bottom line. This is a big reason why insurance companies delay care through denials and prior auths even for the things they know they will eventually cover. It’s also why Starbucks is basically a bank that sells coffee: they have over $1 billion in giftcards. Starbucks gets to invest all of that prepaid money before they incur the cost of actually giving you that delicious brown sugar oat milk shaken espresso.

The easiest way to make money is to have your money work for you.

RP needs (or believes they need) to do this now. Also note, these delays also started around the time RP laid off some of its nonclinical workforce.

This feels like part of a story.

When a “Partner” isn’t a Partner

The other word we need to address is partner.

It should almost go without saying that I can’t vouch for how every contract looks, but here’s the language for one of RadPartner’s “partnership” employment agreements:

Partnership Designation:
During the Term, the relationship between Physician and Practice shall be that of employee and employer and shall not modify or affect the physician/patient privilege or relationship. Unless otherwise directed in writing by the Chief Executive Officer of Practice, the Physician may refer to himself/herself as a “Partner”, allow others to refer to him/her as a “Partner” and refer to such other employees of Practice who have executed this Form of Employment Agreement with Practice as his/her “Partner”, provided, however, that the designation of “Partner” shall be in name only and the Physician shall not be an owner/partner of Practice under the law. Further, Physician shall not have any power or authority to bind Practice in any way, to pledge its credit or to render it financially liable for any purpose unless formally appointed an officer of Practice with such authority pursuant to Practice’s governing procedures and law or authorized in writing by the Chief Executive Officer of Practice.

You are a “partner” in name only.

This is the inescapable reality of choosing a “partnership” track job with an RP group. You are putting in the work in order to take on the responsibility of running the practice without actually owning the practice. It’s just verbal sleight of hand.

Evaluating “Partnership” Opportunities

Sometimes people reach out to me with employment offers and other quandaries for my opinion. (NB: Please note that I am a Person on the Internet and not an expert on most things including contract review).

A reader recently reached out asking for my thoughts on their partnership-track teleradiology-only employment offer with an RP-owned group. The offer included a decent workup salary with high productivity demands that I doubted most people fresh in practice would be comfortable hitting. As in, the W2 sounded very competitive on paper but was actually still pretty extractive taking into account the desired production. That’s not really news. All practices function this way at least to some extent. Partners make money on their employees.

The job also promised “full partnership” in two years with “equal profit sharing.” And this is the crux:

It’s true that whether you work at an independent practice or a private equity-owned group, the “profits” can always be zero. But the profits at an independent group are the profits (revenues minus costs). The profits at an RP group are something else. As United Healthcare argued in its recent lawsuit:

In exchange for these services, Radiology Partners siphons off large amounts of revenue from the medical groups. Indeed, on information and belief, the affiliated medical groups no longer retain any profits resulting from the radiology services that they provide, and all profits are instead kept by Radiology Partners.

An equal share of zero is still zero.

The stock offered to new RP employees is also almost certainly worthless. Don’t view the chance to catch a falling knife as a growth opportunity.

*  *  *

I promise I don’t begrudge anybody their career choices.

And you absolutely don’t need to consider what Random Guy with a Website says.

But if I were considering a job offer at an RP group, I would consider only the workup/employee salary and not make a decision based on the possibility of future increased income as a “partner.” I keep annoyingly using air quotes here for the same reason RP does: There are no partners. There is no partnership.

In each group, there are people who make less money and people who make more money, but they are all employees, and none of them are really actually entitled to much of anything. I won’t pretend to tell you what fraction of groups are happy with their sales and what fraction of groups are making good money and what, if anything, reliably differentiates the successful groups from the struggling ones. That kind of granularity is something that only RP knows, if anyone knows at all. But this much is undeniable: the partners are just employees who are usually paid more. 

*  *  *

If trainees flock instead to independent groups, then radiology private practice will stabilize and the independent model will survive. If they instead take one of the infinite positions offered by RP and their ilk, then they are casting votes for the corporate practice of medicine. I don’t have a crystal ball, but I remain concerned that the downstream consequences of that often understandable individual choice made en masse will be the tacit endorsement of the funding model and the acceleration of falling reimbursement and radiologist replacement.

If you want to work for RP, another PE company like Envision, USRS, or Lucid, or ride the current wave of teleradiology positions that pay relatively well, then you can do that. You don’t owe the field of radiology more than you owe yourself or your family. But it would probably be wise to assume that it is a temporary play and that some component of your job, either the money itself or the quantity of work asked of you, will change in the coming years. Radiology is in the middle of a nationwide shortage that will morph into a big unpredictable shift. Lots of radiologists change jobs, so you certainly won’t be alone.

Some of these are undeniably good employee positions right now. But don’t think for a second that a private equity partnership means you own the business. Because you don’t.


RB 05.30.23 Reply

What a scummy organization. Hope it crashes and burns

Thom H. 05.30.23 Reply

I am a resident currently looking for a job. I am interested in private practice and not academics. In multiple major markets that my family and I are interested in living in, the only option is to work for RadPartners or PE. I have done extensive research and there literally seems to be no remaining independent groups remaining in the metros of these relatively large cities. Unfortunately, I think the damage has already been done. PE owns a monopoly in several US markets and it seems as if this conversation is being had too late…

Ben 05.30.23 Reply

I agree the damage has been done. There are definitely some markets where the main alternative would be to work for a teleradiology position with the hope that things change in the near future. I agree that’s not a very fun proposition.

Sean Meagher 06.11.23 Reply

Take a look at the website for Strategic Radiology to get an idea of communities that still have thriving private practice radiology groups. There are also large practices in other cities which maintain their independence. Ultimately, these decisions come down to weighing the pros and cons. Does your desire to live in a certain place outstrip your desire to work for an independent group. There are lots of great independent practices still out there…

Bill 06.11.23 Reply

It’s fairly common for independent radiology groups to recruit through word-of-mouth and references from current associates/partners. We tried ads in the ACR job listing site a few times. The responses we got were poor. We knew nothing about the applicants and they knew nothing of us.

The hires we made through in-house references have been much more successful. The applicants could discuss the practice expectations/ requirements in-depth with a rad already in the group. We have a very high retention rate hiring rads this way.

If you don’t know anyone already in a rad group you could try cold-calling. But the best way is through a friend already in a group. I hate the word “networking”. Frivolous associations like LinkedIn don’t count. I’m talking someone who worked with you side-by-side as a resident or attending.

Matt 08.03.23 Reply

Its unfortunate the old guard sold their profession out under the guise of large ROI in the future. And its even more unfortunate they try to string along the younger rads coming out of training. I was in a group in Fort Myers that entertained RP. Naturally as a young rad out of training I was very skeptical despite all the “promises” of future riches and dangling of “stock” that had a chance of going public. I saw through the BS and left immediately. Unfortunately, yes most of the major metro areas have sold out in this fashion. Maybe cause the people who want to live in major metro areas are of the same fabric. I luckily have found a group in between Tampa and Orlando that is committed to being independent. Our CEO has made many references to failed partnerships on the part of PE groups not fulfilling their promises and obligations to hospital contracts. Thus, hospitals have become very weary of PE groups which hopefully opens up contractual opportunities for our group, due to local ties, if we are able to achieve strength and stability.

MJ 05.30.23 Reply

In your opinion, does working for private equity owned practice matter more, less or the same for interventional radiologists?

Ben 05.31.23 Reply

As the IR/DR split ages, it seems that more IRs are Iikely to find themselves employed in the future. I also think the practical reality is also that a lot of groups don’t do IR/DR all that well.

From talking to IRs, I think the specifics of the individual position probably matter more than the structure of the paying organization and that any shorthand is probably not very helpful.

My network skews very negative toward PE for obvious reasons, so I am probably not hearing the happy stories.

MJ 05.31.23

That makes sense. Thanks for the response.

Phil Shaffer 05.31.23 Reply

Ben, I wonder if you are familiar with Mitch Li and Bob McNamara. You need to be.
Mitch is heading an organization called “take medicine back”, Bob is the leader of the American Academy of Emergency Medicine. AAEM was founded when a group of physicians realized the legacy organization ACEP, was owned by corporate practices and was not representing physician, but their employers. Recently, it has sued a number of corporate practices for practicing medicine. This is illegal under most state’s laws, but has been sidestepped by these practices with sham ownership arrangements. AAEM’s california suit, in particular, seems to have legs, and may result in a sea change in how CPMs are run. There are obvious opportunities for such lawsuits in Radiology.
The Take Medicine Back organization runs a Facebook page, with a good deal of traffic, and a website. https://takemedicineback.org/about. They are putting on a Summit this june 15th. The program is impressive including Gretchen Morgenson, the pultizer prize winning journalist who just published a book taking on corporate medicine, Bob McNamara, and also the president of the group I am on the board of, Rebekah Bernard.(Physicians for Patient Protection ….https://www.physiciansforpatientprotection.org.

I have written Mitch and told him the two of you need to be acquainted.

Robert McNamara 05.31.23 Reply

Thanks for the props Phil. Ben, been fighting corporate EM for decades. Lead doc for the aforementioned litigation v Envision. Would be willing to chat.

Sunil Kini 06.01.23 Reply

I think you guys are spot on. Rad partners and probably many others are violating the anti corporate practice of medicine doctrine. The corporate mentality doesn’t jive well with healthcare in my experience. I think these corporations are side stepping the law with technicalities. Can RP be sued for this and if so by whom? Or perhaps they can be simply reported to a medical board or other governing body and be investigated for such?

Phil Shaffer 06.02.23 Reply

Here is a link to the Take Medicine Back program on June 15. Anyone can use this – anyone reading this comment. It is free admission


Sunil Kini 06.06.23 Reply

That isn’t verbal sleight of hand, it’s outright blatant disregard. I am jaw dropping amazed at your excerpt from the RP contract that outright and literally says you are a partner in name only but in reality you are not. You can refer to yourself as partner and have other people call you partner but you can’t make any decisions? Are you freaking kidding me?? Isn’t this a clear and obvious violation of the anti-corporate practice of medicine law in place in most states, or are they absolved from that because a certain number of the “owners” or real “partners” happen to be physicians? Is having a certain number of physicians in the ownership group or the board enough to side step this law? What other stipulations might or might not be in place in regards to the law other than ownership?

Ben 06.07.23 Reply

The model is pretty obviously against the spirit of the ban on the corporate practice of medicine, but they and others like them have so far seemed to avoid the issue by allowing the groups to remain technically separate legal entities despite functional/ultimate control. There is a current lawsuit against Envision in California about this for emergency medicine. I suspect many people are waiting to see how it plays out. If successful, I’m sure we’ll see more.

Peter Nefcy 06.10.23 Reply

Physician control over medicine and the practice of medicine died many years ago. And if you want to know why this happened, then look in the mirror. There really is no difference in the end when Medical Societies and Journals did not protect new doctors from being cheated when joining predator practice groups, hospitals hire doctors on salary and set production norms, pharmacy and insurance set up drug panels, Medicare and Medicaid are underfunded based on fake paid RV evaluations, politicians limit and practice medicine in almost all States, corporations use venture capital and borrowed government funds to buy up practice “partners”, malpractice as a function of the better nasty lawyer and friends of Judges, retirement funds are robbed by government regulations favoring certain banking industries and methods, Hospitals consolidating and denying certain services, government regulations that pay more for some groups than others and encourage fake and fraudulent practices, advertising medicines that sort of work a little as cure-alls to the public, huge costs for new drugs that are judged equivalent without testing, government officials looking the other way for universal vitamin scams and scooter scams, and on and on. But especially Physicians who were supposed to be watching and self-regulating the practice of Medicine not taking a stand against all the various means indicated above of making a profit while practicing Medicine without a license. That means you, Doctor.

Harvey Pollack MD 06.11.23 Reply

The independent practice idea is just a fantasy these days. As a physician, and particularly a radiologist, you’ll not own the capital in the form of imaging equipment, so you’re labor. And as labor you’re just an employee, who’s job it is to keep your corporate masters happy.

John Lipman, MD, FSIR 06.11.23 Reply

We’ve been independent for almost 20 years; the first 16 of which as a solo IR. I have one IR colleague and looking for a 2nd and hope to transition this thriving practice on to them over time. It can be done if you’re willing to do the work outside of your day to day practice.

HB 06.12.23

Well I hope your local climate allows you to continue in a profitable and hospitable manner

I can tell you in SE FL as a result of 17 of the groups here you are able to enjoy the practice of radiology on FL. I was able to get all the groups down here to unite and fight Lawton Chiles egregious Fl self referral act that would’ve limited Radiology billing to no more than 115% of Medicare.

Despite the solidarity of all the radiologists in the area the overt and insidious infiltration into the marketplace of for profit hospitals and insurer oligarchs to maintain our independence was a huge loser.

All things are local.

Mario Moya MD 06.11.23 Reply

Stunned to see the contract excerpt defining “partnership” in an RP practice! Yes, it’s true and is included in the agreement! So, you get promised immediate partnership only to discover you are a partner in nothing! Laughable but sad that we consider accepting such provisions as part of doing business with an entity such as RP! Take medicine back and let’s plan and decide how we will redefine and prepare to deliver both IR and DR services in the evolving marketplace! It’s only lost if we allow it to be!

HB 06.12.23 Reply

Dr. Moya,

Just curious, RP is now losing money. Let’s say you joined were a “true” partner in the company, where you were paid a fixed salary and your bonus was dependent on the company’s cash flow, which because it is now negative, meant you got nothing. Additionally, as a partner, beyond the corporate shield, you are personally responsible for loses. Additionally, the tax consequences of that corporation will be passed onto you, sometimes good but more often in this case negative.

Be careful what you may desire to be a partner in.

HB 06.11.23 Reply

I have to laugh when I see some of these comments.

While I am not here to justify PE in our field, I am smart enough to recognize why they exist and how they have helped most of us in an untenable situation.

I think it is time people unplug their heads from their rear ends and recognize that these “private groups” we so wish still existed, lost all their leverage with their hospitals most of which are part of a large conglomerate (private or public) and insurance companies of which there is Medicare (monopoly) or the big 4 oligopolies.

At least PE companies had leverage by representing us as large groups, arbitraging insurance contracts that we could never legally done on our own.

Where we failed as a group was burying our heads in the ground and allowing for profit companies, insurance oligarchs enabled by the government to gut us. Meanwhile United just declared their highest earnings ever and increased their dividend 14% while we excoriate RP (and others) for running short in funds in a fixed environment guaranteed to undermine them and us.

Being a partner in a worthless and ever declining AR in a “private group”, where pay is declining as well is as worthless as being a “partner” no matter how absurdly defined with RadPartners.

HB Naysayer 06.12.23 Reply

Usually when someone says, “I am not here to justify XYZ”, they actually are. Pretty sad that some people are either so clueless as to think PE is saving people from “untenable” situations, or perhaps they are in fact some RP shill that came to this forum to spread misinformation. The fact is radiology private practice is thriving in the vast majority of instances, particularly in groups 30 or larger. And if someone thinks PE is out to use leverage or other such nonsense for the benefit of the peon radiologists, they are either PE bought and owned or severely limited in forward thinking. If PE makes it out alive from this radiologist shortage and somehow finds itself in a radilogist glut, those employees will have their salaries gutted, production quotas increased or perhaps a combination of both. It blows my mind that people can think that PE is a positive force in any way, shape or form. Just read about what private equity did to nursing homes.

Naysayer toHB Naysayer 06.13.23

OH, I see YOU are one of those so-called “tolerant” people while spewing your intolerance.

The fact is Radiology private practice like other medical practices is NOT thriving. More of us are employees and our reimbursement is decreasing significantly relative to cost of living while our productivity has been increasing. While we radiologists are doing slightly better than other specialties in maintaining our “independence” every year, more of us are becoming employees. Pretty much the only positive economic force in our specialty is the absurd increase in utilization of radiological services resulting in a shortage of the radiology workforce; there already forces out there that want to hold US responsible for this exponential increase in utilization and I wouldn’t be surprised if we witness the ACR in enabling this movement.

Why has PE had such an impact on Radiology as well as other hospital-based practices? Because of the ever-decreasing Medicare fees, the ability of for profit (and not for profit, whatever that still means) healthcare systems to squeeze and threaten groups in hostile environments and most importantly, by convincing those like yourself, with successful propaganda that surprise billing is in the best interest of the patient, the country and healthcare in general while all it has been is a license for insurance oligarchs to make even more money; UNH just declaring record profits and raising dividends 14%. As we are now witnessing, this has been a hammer to all providers which have been no “surprise”.

Some of us have seen significantly better cash flow with PE. Some of us have witnessed much stronger negotiating with insurers and hospitals than we could ever have done independently. All market dependent and strictly a function of the forces that we as a group of doctors have allowed to happen.

Do I think PE is a “positive force”? Did I say that? Like in the nursing home environment, you are distorting, it is the result of healthcare being destroyed by “for-profits”, insurance oligarchs and most importantly our government who have successfully, with the help of our societies of commoditizing us. While we played ostrich, with the help of the ACR and other “advocates” we got our proverbial clocks cleaned. I hate to tell you, but PE ONLY represents 5% of nursing home takeovers. The nonsense being spewed by this administration of an increase of 10% mortality in nursing homes when PE entered is just more propaganda for the crowds like yourself. The mortality has increased in the other 95% as well and has to do with the abhorrent reduction in reimbursement for services. Once again, PE entering is the result of gutting rather than causing of the gutting.

As to being a “shill” few if any have spent the time and money, I have in fighting the forces that so many in our field have willingly fallen prey to. Despite our/my success in thwarting FL Lawton Chiles in fighting off limiting our fees to 115% of Medicare in his asinine FL Self-Referral Act, those in our field including the ACR, have been instrumental in enabling the forces that have enabled PE in our profession.

Sorry IF the reality of our dire circumstances offends you but while reality may be offensive it is what it is.

Devang Gor 06.11.23 Reply

Independent private practices are still doing well. It’s depends on location. The partnerships are real with shareholder status and distributions. There are MSOs like Unified Radiology which help independent practices remain independent. The job market and current offerings are not sustainable and will change over time.

HB 06.11.23 Reply

Yes depending on the “location” is the key. Not in cities, or most locations with large populations. In MOST of the country the government, for profit entities and insurance oligarchs have literally decimated private practices.

Sorry “independent practices” are NOT doing well and are far and few between. Nothing would make those of us who have witnessed our practices destroyed to still be viable but thanks in no small part to the ACR and other “helpful” organizations, working with the “government”, that just isn’t the case.

Are you really discussing MSO. LAUGHABLE

Jeff A. Younger 06.12.23 Reply

Preferred Radiology Alliance, PLLC in Florida is working hard to maintain the independent practice of medicine. Our nine groups with over 240 radiologists benefit from economies of scale and shared best practices.

HB Naysayer 06.28.23 Reply

Just a hunch, but it seems HB is one of the private equity sellouts. He either convinced himself that he was salvaging an “untenable” situation when it seems shorterm money was/is his motivating factor. Very shortsighted thinking to paint PE in any positive light whatsoever. It seems he swallowed their pitch of “we can negotiate rates with better leverage, economies of scale, technology (AI) yada yada yada”. Even if that is true, that money is not going into interpreting radiologists’ pockets. And zero chance any significant percentage of PE radiologists are making more money under private equity than they would under an eat what you kill arrangement. The only ones that may apply to are IR and mammographers because of market forces albeit at the expense of other remote/onsite rads. Even the sellouts come back to breakeven status after 5 years in the vast majority of cases. Why do you see so many rats abandoning the ship once they’ve vested? It’s really very simple, PE gets a fixed amount of money in accounts receivable and skim 30% plus off the top while distributing the rest as underpaid radiologist salaries. You would have to be an ostrich to think their negotiating leverage, economies of scale or technology can get anywhere close to replacing that 30%. I would like for HB to report back how his private equity overlords are treating him when the radiologist shortage abates. Lucky for him that may not happen anytime soon. But if it does, his salary will be cropped another 20-30%. So sorry if you’re triggered HB, but I stand by my interpretation: HB is either a private equity shill or just simply doesn’t understand how private equity works.

Jeff Younger presents a compelling group in PLLC. That is almost certainly what a bright future in radiology looks like. Economies of scale and shared best practices for the benefit of the radiologists not for the benefit of PE C-suite and investors- and at the expense of radiologists who have invested a lot of time and effort to be compensated fairly.

SP 06.28.23 Reply

Quit healthcare. It was a simple decision and have never been happier. Plenty of opportunities out there! Wish everyone the best!

brandon 10.12.23 Reply

Radparters- an excellent use of Orwellian doublespeak.

Can we call their accounting department the Ministry of Plenty?

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