Editor's Page

Group Practice Magic


Fam Pract Manag. 1999 May;6(5):7.

One aphorism we have heard frequently from practice integration consultants over the past few years is, “The magic is not in the model.” That is, there is no “best” integration model: The fact that, say, a physician-hospital organization (PHO) down the road is going great guns doesn't mean that a PHO is what you need. While I believe the aphorism, I confess a certain preference for the model highlighted in our cover section: the physician-run group. H. Jeffrey Wilkins, MD, and his coauthors do a good job of highlighting the benefits of the model in their article.

Still, I can't quite agree with Wilkins and company that “physician-owned primary care groups are the best strategy for physicians, for our health care system and for our patients.” There is no magic model. The magic doesn't even lie in integration per se. Read the three articles attentively, and you'll see that what makes the group model seem magical is the confluence of a number of factors:

  • The right people. Success depends on the involvement of people who are willing to put the agenda of the group ahead of their own individual agendas, as Joseph A. Cincotta, MD, suggests in his article. Success demands people who think enough alike to get along and differently enough to stimulate each other intellectually. It also requires willing and capable leaders.

  • The right attitude. What is needed is a thoroughgoing confidence that looking out for number one is counterproductive, as well as an eagerness to search for solutions that benefit everyone involved, and the patient most of all.

  • Business sense. Without the ability to understand what the market needs and how to provide it, success is impossible. (This is what the Wilkins article calls being “strategically savvy.”)

  • Unity. In part, this is “groupthink,” in the sense used by Cincotta. But it also requires a structure that provides appropriate incentives for all members — aligned incentives.

There. That's the magical formula, give or take.

It's not helpful, you say? Well, not very, I'll admit. My four points will all collapse into the first one if you apply a little pressure. You need the right people, who have the right combination of aptitudes, attitudes, principles and knowledge. Without them, you have little chance of success, even implementing the latest killer model. But once you have those people assembled, your efforts stand a good chance of success, whatever organization you build. That's the magic. And it may just be easier to assemble the right people if you're building a physician group than if you have to work in hospitals and other miscellaneous entities.

If you find this thought depressing as you look around you at potential partners in your area, I can't blame you. The proverbial task of herding cats is both an unrewarding occupation and a full-time job. It doesn't leave you time to build anything. But if you find even one or two physicians who fit the bill, you may be on your way to building a group that will lead others to say, “I knew it! The secret is in the group model!”

Robert Edsall is editor-in-chief of Family Practice Management.


Copyright © 1999 by the American Academy of Family Physicians.
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