What diligence should a new anesthesia attending run on a private practice group?

Four things, in this order: who owns the group, whether the owners plan to sell before you make partner, how many physicians left last year, and whether the hospital contract is exclusive and when it renews. Then call two physicians who quit in the last two years.

1. Who owns the group, and is private equity in the picture?

Ownership decides whether your partnership track is real or theater. A physician owned group that has never taken outside money has one set of incentives: keep the contract, keep the physicians, keep the money inside. A group that sold a majority stake to private equity or a national platform has another: hit the growth targets, then sell again in 5 to 7 years.

If PE is in the picture, ask directly who the majority owner is and what percent the physicians still hold. A group where physicians own 49 percent and a fund owns 51 percent is not a partnership track. You need the partnership agreement language before you sign, not after. Ask what a partner unit costs, what it paid out last year in dollars, and what happens to your buy in if the fund sells the platform.

2. Does the investment horizon end before your partnership starts?

This is the timing question that sinks people. A typical PE backed anesthesia platform gets sold or recapitalized every 5 to 7 years. If the group sold to a platform three years ago, the next sale lands in 2 to 4 years. If your partnership track is 3 years, you might vest right as the new owners rewrite the deal.

Ask: when did the current ownership structure start, and when does the fund expect to exit or recapitalize? Then map it against your track. A 2 year track against a 5 year horizon is fine. A 3 year track against a 2 year horizon is a trap: you arrive at a partnership that no longer exists in the form you were promised.

Physician owned groups have horizons too. A senior heavy group with five partners over 60 and a buy in of $250,000 is a different deal than a group with a deep bench of 40 year olds. Ask for the age distribution of the partners.

3. How many physicians left last year, and why?

Turnover is a signal in any anesthesia group. A stable group of 25 anesthesiologists loses 0 to 2 a year, mostly retirements and relocations. If 5 left a 20 person group in one year, something is broken: call burden, compensation, leadership, or all three.

Ask for the number directly: "How many physicians left in the last 12 months, and how many in the 12 months before that?" Then ask who replaced them. A group that lost 4 and hired 2 is shrinking. A group that lost 4 and hired 6 is rebuilding, which is fine but means you will carry extra call while the new people get credentialed.

Do not accept "they moved for family reasons" as the full story. Sometimes that is true. Sometimes it is the polite cover for a pay cut or a scheduling war. The departing physicians will tell you the real version.

4. Is the hospital contract exclusive, and when does it renew?

The hospital contract is the group's entire business. An exclusive contract means the hospital cannot bring in a competing group or staff the ORs with locums permanently. A non exclusive contract means you are one bad quarter away from a bidding war you cannot control.

Get two facts: is it exclusive, and what date does it renew? A group 2 years into a 5 year exclusive renewal with a hospital CEO who loves them is a stable seat. A group 9 months from renewal with a new hospital administrator shopping for lower rates is a seat you might not have by the time you are a partner.

Also ask what happens to your employment if the contract is lost. A single hospital group that loses its contract often dissolves, and your noncompete may still be enforceable even if the group is gone. Read that clause twice.

How to find this information

You will not get all of it from the recruiter. The rest you assemble yourself:

• Ownership and partner economics: ask the group directly, then confirm through the partnership agreement. Your contract attorney (not the group's attorney) reads it.
• Turnover: ask the group, then cross check with physicians you know in the region and the two departed physicians.
• Hospital contract: ask the group for exclusivity and renewal date. Confirm the relationship with surgeons and OR nurses on your interview day. They know exactly how the anesthesia group is viewed.

Call two physicians who left in the last two years

This is the highest value hour of your entire job search. Find them through your residency network, the state society, or LinkedIn. Most will talk. Frame it as respect: "I am considering joining your old group and I would value your perspective."

Ask these questions:

1. Why did you leave? (Then wait. Silence gets the real answer.)
2. Was the call burden what they said it was during interviews?
3. Did partners make what you were told partners make?
4. Would you send your best friend from residency there?
5. What do you know now that you wish you had known before signing?

Listen hardest to question 4. People dodge around reasons. They do not dodge that one.

Take notes after each call. If both departed physicians independently mention the same problem, believe them.

A contract attorney review of your employment agreement runs $1,500 to $3,000: at $450,000 a year a working day is about $1,800, so the review costs one to two days of pay. Do not skip it.

For the full breakdown of what belongs in the contract itself, see the contracts guide. For the bigger picture, head back to the Anesthesiology New Attending hub.