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Today's Practice | Apr 2010

BONUS FEATURE: Pearls for Planning a Team Approach

Factors to implement when setting up a group practice.

A group practice, when planned correctly, incorporates the best elements of careers in private practice and academia. The group practice model, like private practice, promotes personal and long-term relationships with patients. At the same time, working in a group encourages medical and scientific exchange with peers as in an academic setting. Additionally, a team approach can stimulate members to be self-determined even as time and economic resources are synergistically managed. To create such an environment, there are several factors that must be considered when planning a group practice. This article offers some pearls for building a team approach.

Partners must share a common vision for the direction the group practice will take. Making a lot of money or having time to play golf are not good reasons to join or create a group practice. This kind of thinking is a trap and is not realistic.

Trust and generosity are essential in any partnership; future partners must profoundly trust one another. When in doubt, one must assume that trust is warranted until proof suggests otherwise.

Misunderstandings among partners will inevitably happen, but this does not mean a partner cannot be trusted. When an argument among partners occurs, they should argue facts, not justice. If an argument cannot be settled and there is not a provision in the partnership or employee contract, the contract should be amended for future cases.

Each partner should have his own claim to fame in the practice—a field of outstanding competence in which he is not competing with another partner. In scenarios where there is a lead partner, that partner's authority must be accepted beyond just his age or ownership; the lead partner must be respected on a human and professional level. Group practices among equals may work fine, but having a leader is not a bad thing because it provides a recognized authority in cases of internal disputes. If worse comes to worst, the lead partner serves as a stable pole in the storm, around which, after the hurricane passes, a new village can form.

Do not mix personal with professional business. When in doubt, err on the side of distance rather than closeness with peers. If family members are on the team, clear rules must be spelled out, and utter correctness is mandatory.

When setting up partnership contracts, it is important that information about income, benefits, scheduling, and termination policy are clearly presented. The contract must regulate any possible future split between the partner or employee and the practice. As paradoxical as it may sound, the split-up should be planned at the start of the relationship. Do not make compromises from the start because there will be ample need for compromises in the future.

The team or lead partner must determine what new members will be expected to contribute to the group practice. It is wise to determine this before launching a search for a partner. In my experience, it is best only to accept an applicant that all of the partners agree will be a good fit.

To build a surgery team, do not look for inferior team members. Instead, think of each potential surgeon-partner as an asset and an opportunity to expand the team's capacities. Patient volume will increase as each team member develops his own reputation in the community. If initially there is one prominent team leader, the other partners have time to grow under his umbrella. But, ultimately, in order for the practice to grow, partners cannot be content to sit in the passenger seat. They must grow their own identities. And they must do so not to compete with their leader or partners but rather to compete with other practices.

As health care systems vary throughout Europe, there is no general, patent recipe for increasing a practice's income. However, there is one principle that all group practices can follow to garner financial success: If the staff and team members are good, friendly, and available, income will be more than comfortable and will reach, at least within an order of magnitude, what can be reached in that particular society and health system.

If you focus too much on tickling the last cent out of your practice, you lose that time for more important issues. In the end, this strategy will neutralize your effort, if not counteract it. Patients do not like doctors who appear to be more concerned with money than with the welfare of their patients' eyes.

Thomas Neuhann, MD, is Senior Partner of a group practice, Head of the Ophthalmological