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You can do it all, or do some of it better.

Fam Pract Manag. 2008;15(5):6

The April Harvard Business Review contains an article that caught my eye because its title – “The Four Things a Service Business Must Get Right” – made it seem applicable to the typical family medicine practice.1 While the article as a whole offers useful advice, one passage in particular seems to have “family medicine” written all over it: “Inevitably, companies that attempt to be all things to all people begin to struggle when upstart competitors … start picking off profitable niches.” According to the article, trying to provide a complete range of services is incompatible with achieving excellence in any of them. In other words, a competitor focused on any one of the services you provide might do it better. Compared with your practice, for instance, a retail clinic may be able to provide better access for minor problems, a hospitalist practice may be able to provide better hospital care, a care-management company may be able to provide better follow-up for patients with diabetes, etc.

The solution, according to the article, is to become “multifocused,” providing excellent service in several niche areas across your range of services instead of trying to do it all, especially if your areas of focus can all be supported by the same infrastructure for economies of scale. It's easy to imagine how some organizations could do that, but can a family practice do it and still offer something that could be called family medicine?

It may be a stretch to say this article applies to the typical practice, given that the author was writing about service companies in other industries. Still, applying it does suggest potentially productive questions: What parts of your current range of services would you focus on? Which might you give up to focus more energy on others? Which services fit well together and which don't? Would you emphasize prevention and chronic disease care? Would a practice focused on hospital care and house calls work better than one focused on hospital care and office practice? (Would you even need exam rooms?)

I don't know the answers, but it stimulates the imagination to think about multifocused practice configurations, and it's nice to think that family physicians might not need to be the 97-pound generalists getting sand kicked in their face by every niche bully to come by.

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