Partner Conflicts: Fatal or Solvable?

Neil Chesanow

Disclosures

June 26, 2015

In This Article

Conflict Is Inevitable

"Hell," the philosopher Jean-Paul Sartre once wrote, "is other people."

Many physicians who have practice partners learn this lesson the hard way. Sometimes the doctors they choose as partners may have a problem with alcohol or drugs. Some may have mental health issues. Some may have difficult or ornery personalities. Some may have or develop issues with physical health.

By far the most common problems, contends attorney Ellen F. Kandell, JD, president of Alternative Resolutions, a conflict-resolution firm in Silver Spring, Maryland, arise from normal business situations and may create conflict based on differences in values and personality traits. Depending on how they are handled, they could either spell the end of a relationship, lead to further problems due to simmering hostility, or be solved effectively. Kandell offers some examples.

A young doctor buys into a practice for a hefty six-figure sum. As low person on the totem pole, the doctor is given more call than more senior partners. At first, the doctor accepts this situation, but when it hasn't changed years later, the doctor feels taken advantage of. She is reluctant to speak up, but the wound begins to fester. She brings it up to her partner at a meeting, but the doctor refuses to discuss it, although the junior doctor makes several attempts to broach the subject. In this situation, the doctor's productivity may slump. She may start burning out. She may eventually threaten to quit and, in an attempt to recoup her financial investment, she may sue the practice.

Or suppose the lead physician or practice founder decides to transition into semi-retirement. As a result, he may work fewer hours. His call may also be reduced—or sometimes eliminated—while he may actually be taking more money out of the practice than before, leaving his partners with more call and ultimately less compensation. Although this may leaving them fuming, they may nevertheless be loath to speak up, Kandell says. This may be because the top doctor was vindictive in the past when partners complained, perhaps exacting retribution in the form of less time off and more call. But if the situation isn't addressed, some partners may decide to leave the practice en masse.

Competition among partners can lead to passive-aggressive behavior. For example, an older physician with more clinical experience clashes with a younger partner whose medical knowledge may be more current because he recently completed residency training. Or the practice rainmaker might "steal" patients from younger partners to maintain his high productivity. Or an older doctor publicly puts down a younger doctor, nurse, or member of the administrative staff, sending ripples of unrest through the practice.

In another possible scenario, the practice adopts an electronic health record (EHR). The younger doctors, who grew up with computers, may quickly master the basics, even though they may have some gripes. To some of the older doctors, though, it's a hard-to-learn, unintuitive, error-prone, time-wasting, depersonalizing intrusion into patient care, an attitude that their younger colleagues may treat with disdain. The upshot: The older doctors vent their anger and frustration to the staff; to their younger colleagues, who express little sympathy; and worst of all to patients, cleaving the practice into feuding camps which threatens to undermine the esprit de corps.

"Every practice will change over time," Kandell observes. "Change and growth are good," she maintains, "but they generate conflict, and most doctors don't manage conflict well." If this sounds like you, she offers some advice.

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