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Fam Pract Manag. 2001;8(1):11-12

To the Editor:

In “Implementing a New Plan to Compensate Physicians” [September 2000, page 29], the “simple” Rube Goldberg scheme (which produces quarterly bonuses by dividing 10 percent of the group’s net income according to eight criteria) predictably resulted in a rebellion. So, what’s the point? Amazingly, the plan penalized partners who used a nurse to return phone calls. I have two nurses who do almost nothing but that. How is talking on the phone boosting productivity?

As I pointed out in my article, “Solo Practice: The Way of the Future” [February 1998, page 16], “Groups have a bias for argument, posturing, ego gratification, procrastination, blame shifting — anything except action. Even if committee meetings are your idea of recreation, do not confuse them with organizational effectiveness.”

Come on, guys. You’re making practice more difficult than it has to be. If you must be a “groupie,” set up your group as an association of solos, share the space and avoid the headaches.

Author’s response:

Dr. Iliff is a strong proponent of solo practice, and I wish him well in his lone pursuit. However, many of us enjoy the benefits of group practice.

Dr. Iliff misses the point of the compensation plan. It is a method to reward achievement above the mean and to assign costs greater than the mean to the physicians responsible for them. The telephone is a good example. Some of the doctors in our group also feel that they are more productive not returning calls, but by using this plan, they pay for that privilege — as do solo physicians who pay nurses to return calls.

I do not agree that groups do not take action. Developing this plan was an action undertaken by the group — as is our current search for an electronic medical record system. We don’t make instant decisions, but most of the time the input from four heads is beneficial to us all.


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