As medical management consultants, we’ve come to the conclusion that there are commonalities among dysfunctional medical groups. Frequently the core causes of dysfunction lie in differences among group members that were either never addressed or that were left unresolved. Typically in a dysfunctional group the members respect their colleagues’ clinical skills, but an element of trust is missing. However, a lack of trust is just one of the underlying factors that contribute to a group’s dysfunction.
Alert to the Alarms
What are some common elements and behaviors that negatively impact a medical practice? “I” Versus “We” It is not unusual for physicians to view their place in the world from an “individual” rather than an “organizational” perspective. “I” and “my patient” are far more frequently heard than “we” or “our group.” Correlatives of an individual frame of reference that are not conducive to successful group practice are:
- difficulty feeling allegiance to their practice organization;
- difficulty seeing long-term benefits from collective behavior; and
- disregard for protocols dispensed by the group’s governing body.
It is common for physicians within a dysfunctional group to consider staff as their own rather than the group’s. This leads to a staff that is frustrated by trying to honor multiple and conflicting directives, which in turn leads to physician complaints about how inefficient staff is. The bottom line is that when physicians belong to a group, but practice medicine as if they were solo, the entire practice suffers.
Disparities in Income Distribution In some groups there can be a wide disparity in the revenue generated by members of the group, largely because of seniority, experience and subspecialization. Add other specialists like neurologists or physiatrists into the mix and things get even more complicated because the disparities are more dramatic. Moreover, in personal service businesses like neurosurgical practices, income distribution often is a zero-sum game. That is, when one neurosurgeon’s compensation increases, it directly impacts the partners by lessening their income. Even though an increase in compensation usually results from a doctor’s increased productivity, the emotional index can be high. This situation contrasts with the world of corporate business, where pay increases come from the general funds of the organization without direct impact on other employees.
Academic Training Versus Business Experience
An indirect cause of medical group dysfunction in the areas of business management springs from medical training programs that give little or no attention to business management-revenue generation, expense control, proper coding, computerization and the like. The result can be a lack of unified commitment within the group to pragmatic indexes of group success, exacerbating friction among the partners who may lack the tools for making the best management decisions.
Avoiding Constructive Conversation We often see circumstances in which physicians avoid productive conversation with colleagues regarding areas of sensitivity. This can be especially true when money is an issue. It is important to distinguish between “having a disagreement” and “being disagreeable.” Avoiding constructive dialogue is itself a barrier to resolving disputes, and perhaps more importantly, it precludes early detection of potential flashpoints. When they are not addressed, concerns may not surface until emotions are at a boiling point.
Joined Group for Wrong Reasons Practical reasons why physicians join groups are to get call coverage or to negotiate more and better managed care contracts. While these certainly are factors that render a group practice attractive, they are not primary goals and they will seldom be enough to sustain a group practice through the inevitable disagreements among partners.
Dissolving Discord If you are a satisfied member of a thriving and functional group, be sure to celebrate. But if this article has set off an alarm bell for your group, the time is now to begin to effect change. Your practice has a better chance of blossoming in the long term when the roots of dysfunction are recognized today and solutions can begin to be identified and implemented tomorrow. Karen Zupko is president of Chicago-based KarenZupko & Associates, Inc., and James Stuart is a consultant with the same firm. KZA is a practice management consulting group that works with neurosurgical practices nationwide and also participates in the AANS Coding and Reimbursement Workshops.