Pulley vs. Carta for Clinicians Growing Into Ownership

For each clinician, write down their actual history: when they joined as a contractor if applicable, when they became an employee, and whether any ownership conversation has happened, formally or informally. Include clinicians who were told they were on a partner track even if nothing has been granted yet.

This reconstruction usually surfaces inconsistency the group did not realize it had, one clinician promised equity after two years, another after four, with no documented reason for the difference beyond who happened to be running the practice at the time each promise was made.

Groups that have gone through a few rounds of practice manager turnover tend to find the biggest gaps, since each manager brought their own informal sense of what a partnership conversation should sound like, and none of it was written down consistently enough for the next manager to pick up where the last one left off.

Write down a consistent set of criteria for what earns a clinician a path to equity, tenure, a caseload or revenue threshold, or both, and apply it going forward. This does not need to be rigid to the point of ignoring individual circumstances, but it needs to exist, so the next promotion conversation is not invented from scratch.

Groups that skip this step end up with equity offers that look arbitrary to the clinicians who were not offered one, which is a retention risk in an industry where good clinicians already have other places to go.

Share the criteria with clinicians directly once they exist, rather than keeping them as an internal reference only leadership sees. A clinician who knows exactly what the path requires is far more likely to stay and work toward it than one guessing at an unwritten standard.

A clinician who is still primarily a contractor is often better suited to a profits interest or phantom arrangement tied to their own production, rather than full equity with governance rights, until they have actually transitioned to a committed, ongoing role in the practice.

Save real equity, with its voting rights and access to practice financials, for clinicians who have moved into something closer to a true partnership, where those rights make sense given their actual involvement in running the group.

This matters because a contractor relationship can end on relatively short notice in most states, and a group that has already granted full voting equity to someone in that position may find the exit far messier than the original retention goal ever justified.

For a group with one entity and a straightforward, if inconsistent, history of promises to clean up, Pulley can be a simple place to record real equity grants once the underlying terms are settled, and a 409A valuation is generally needed for option-based grants.

It will not resolve the inconsistency in your history. That work has to happen first, using the reconstruction from step one.

Carta becomes the better fit for a larger, multi-location group that wants to benchmark clinician compensation and equity offers against comparable practices, or one that is consolidating several smaller practices into one structure and needs to represent multiple entities during that transition.

For most single-location groups working through their first handful of partnership conversations, this is more than is needed at the outset.

Some clinicians work part-time across two locations owned by related but separate entities, which raises the question of whether their equity, if any, sits in one entity, both, or a parent structure above them. Resolve this explicitly rather than defaulting to whichever entity happened to issue the offer letter.

A clinician's actual working relationship should drive where their equity sits, not administrative convenience. Getting this backward creates exactly the kind of mismatch between what someone was told and what the paperwork says that causes disputes later.

Clean up the equity trail in this order:

1. Reconstruct each clinician's history, including contractor start, employee date and any ownership conversation, even informal ones.
2. Write consistent criteria for earning a path to equity, such as tenure, a caseload or revenue threshold, or both.
3. Offer contractors a profits interest or phantom arrangement tied to their own production, saving real equity for committed clinicians.
4. Decide explicitly which entity holds equity for a clinician who splits time across two related practice entities.
5. Record real grants in Pulley or Carta only after the underlying terms are settled.