Recruiting a partnerBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7110.S2-7110 (Published 20 September 1997) Cite this as: BMJ 1997;315:S2-7110
- Ray Wilcox, management and recruitment consultant to general practice
Practices should carefully review their workload before advertising for a new partner, argues Ray Wilcox, whose work as a management consultant takes him to many practices at times of change
In my work with practices I see many approaches to the recruitment of new partners, most of which are rooted in history and tradition-which is often inappropriate for today's market. Doctors who began as junior partners 30 years ago recall their own recruitment and follow a similar model, but many practices fail to appreciate that the marketplace is changing. Contracts are short term not long term, flexible not rigid, temporary not permanent; and it's a buyers' market.
Persuading a doctor to join one practice rather than another requires a different, more detailed process from that used in the 1970s and 1980s. Options and alternatives need to be explored by all partners, because these will affect the way you work, your income, and your values. Several stages need to be considered before any practice should even think of advertising.
Specifying the package
Some negotiating points to consider:
Will we want them to “buy in” and if so when?
An increasing number of general practitioners are interested in avoiding the commitment that comes with “buying in.” And companies are increasingly keen to invest in general practice, including, in certain circumstances, buying out the capital from existing partners.
Time to parity
How flexible will you be (donõt become unnecessarily fixed on what you did last time)? What will it cost you personally if you shorten the time to parity? Can you afford not to?
Responsibility for practice business matters
Many practices expect partners to have an interest in one or more business aspects of the practice-computers, finances, staff, etc. Sometimes these are best agreed once the partner is in place, but it can be flagged up at this stage.
What if the new partner wants a half day where one is not currently offered; or wants a particular half day that is not usually available?
Are clinical assistant posts encouraged or allowed? What about other fee earning opportunities? Is all money pooled? If the answer is usually “yes” would you allow it not to be?
Where will the partner be allowed to live?
Will you specify an area around the practice within which the new partner must live? What if this is a problem? This issue does cause some tension, particularly if partners already at the practice were required to live in the area at the time when they joined the practice.
Out of hours work
More often than not this is an issue resolved by deputising services or general practice cooperatives. But what if the incoming partner has an alternative view of the partnership policy?How flexible or encouraging will you be?How flexible or encouraging will you be?How flexible or encouraging will you be?How flexible or encouraging will you be?
The secret is to take the time to share views, analyse options, and put yourself in the position of those seeking jobs in today's market. Increasingly, principals are prepared to change career direction. Options for locum work, general practice cooperatives, sessional work, and short term work, all erode the traditional long term, full time, equity owning career in general practice.
If you need to find a new partner because a previous partner is leaving it is important to find out why the partner is leaving. The idea of an exit interview-in which outgoing employees are asked to feed back their reasons for leaving once they have resigned is well established in other areas of employment and can be usefully applied to general practice too.
Getting the information is one thing-and perhaps you already know the information that would be fed back to you-but doing something about it is another. One practice I worked with knew what its problem was after the departure of a second partner in six months. At the exit interview the leaving partner told me openly that ineffective decision making, tensions between partners, and an absence of any feeling of the partners being in control had led to his decision to leave. The partnership had known of the problems six months earlier but had not been able to sit down together and agree a way forward. Only by working through the issues with me over several months and deferring the replacement of a partner while they talked, were they able to tackle them. They eventually decided to form two separate partnerships. Remember also that when someone joins a practice as a partner and it is the intention of all parties that this is the case then a partnership exists “at will” even if no written agreement is signed. The BMA offers comprehensive advice on the subject of partnerships.
Reviewing the alternatives
Just because a partner is leaving, or the workload is rising, does not mean that another partner is the answer. More partners reduce your income, and while the state will finance much of the cost there is always a negative impact on the profit margin with an additional partner-at least in the early days. “Skill mix review” is the process of looking again at what people do at the moment (in this case what the practice team members do) and considering alternatives. So much of what happens internally in a general practice follows tradition, and it is often difficult to break the habits of a lifetime. The most difficult thing is to get partners to begin to be able to think about alternative possibilities. Once everyone will agree to do this, the possibilities for change begin to flow. Using protected time away from the practice to make important decisions helps, but you must also agree a method of implementing decisions.
Reducing workload by controlling list size is relatively easy to implement over a phased period by closing the list or reducing the practice area. Greater use of practice nurses is also an option, although, despite much talk, there has been little movement towards making this a reality in my experience. How much medical time would be freed by employing a social care worker? To what extent could your appointment system or visiting systems be improved or changed? Would some part time medical help or a long term locum avoid the need for a partner? More radically, could you merge with another practice?
What sort of person?
Once you have considered these issues and decided to recruit a new partner, the next stage is to draw up a person profile that specifies your preferred candidate. How old do you want the candidate to be? Will you be interested in someone outside the normal age range of 25 to 28 for a newly qualified GP?
Do you want a man or a woman? There has been a sea change in thinking on this subject in recent years. At one time a female partner had to take a full commitment of nights and weekends to get a partnership, but not having a female partner can put you at a positive disadvantage-a female partner brings a new service for the patients and a new perspective to the practice culture.
It is against the law to specify the sex of applicants in your advertising material, and there is an increasing body of influential opinion that wants advertisements to avoid reference to age, which may shortly be codified by the European Union. Do you want just conventional qualifications, or do you particularly want someone to bring a skill to the practice that it currently lacks? Or do you want a special qualification or type of experience to fit with the future direction of the practice? What special interests would you look for or what special interests would you allow? Are you looking for a budding medicopolitical star, an audit enthusiast, or a future managing partner?
Values and beliefs at both a personal and professional level are really important. Our beliefs and values are the glue that binds us together. If you find that the values that a new partner brings are at odds with what exists at present it goes without saying that you have a recipe for difficulties. Take time through formal direct questioning and informal and relaxed discussions-perhaps over a drink-to establish what the potential newcomer's values are.
Full time or part time?
Not everyone wants to work full time, and you need to think whether someone working part time can easily be accommodated. How might you reorganise what you offer, to accommodate the right person, who may only want to work half time? A clear position on this and other points should be agreed within the practice before going to the outside world to seek a new colleague (see box).
Getting ready for change
I was asked to help a practice that had some interpersonal and organisational problems and which wanted another partner. As one partner said to me rather good humouredly, “Who would want to join this mess?” And it does raise the point about whether you should be absolutely honest with candidates about any existing partnership tensions. The golden rule has to be not to invite a new partner into personal and organisational problems that you should be sorting out beforehand. It never solves the original problem; it just involves more people in it. Four organisational strengths always stand the practice in good stead when change or a significant event occurs: regular communication between partners, good support networks for partners, good decision making arrangements, and regular time out to look forward.
Getting ready to introduce another person into your professional practice can be stressful. It behoves any practice to take the time to prepare well because that time is more likely to reward you with a successful appointment and a fruitful partnership.