What Physicians Want

Philip Betbeze, for HealthLeaders Magazine , June 9, 2010
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A group practice offers benefits of hospital employment, but in a physician-owned model.

Physicians just don't want to work in private practice anymore. Or so the prevailing wisdom would have us believe. Instead, says this line of thinking, with few exceptions, new doctors just want steady employment, preferably in the hospital environment, where all they have to do is take care of patients instead of dealing with the billing and staffing challenges, and all the other headaches that a physician in private practice is expected to take care of.

The problem with this theory is that it's only partly true. It's true that, generally, as bureaucratic and paperwork nightmares of the private practice physician mount, it is more difficult for such so-called "mom and pop" operations to compete for talent. Even larger multispecialty practices are seen losing out to hospital-owned practices and hospitals themselves, as inpatient facilities ramp up hospitalist hiring.

Still, contrary to the prevailing wisdom, new physicians don't necessarily want to work in the hospital. Yes, they want a flexible work environment and they want to spend their time taking care of patients. But that doesn't mean those activities have to take place within a hospital's four walls. Instead, innovative private practices are structuring their offerings to new physicians around a stable, entrepreneurial work environment in which all the extraneous details that don't involve patient care are done by administrative staff.

An example can be found in Community Care Physicians PC, a 35-office, physician-owned group practice based in Latham, NY, where founder, chairman, and CEO Shirish Parikh, MD, says satisfaction in their jobs—particularly interacting with patients—is the main driver motivating physicians. His challenge is to offer as much flexibility as possible to physicians. What's good about that approach is that it's exactly what patients want as well.

"Compensation, and perhaps surprisingly, security, are important," says Parikh, "because it seems like hospitals don't fail as frequently as groups."

Every physician at Community Care, which was founded in 1985, has an opportunity to become a shareholder. To begin, each is employed, but at the end of his or her second year, shareholders can nominate the physician to become a shareholder, after which he or she can decide to remain employed or buy shares. About 100 of the 180 physicians it employs are shareholders. The practice's strategy has been successful precisely because Parikh and Bob Kleinbauer, the practice's chief operating officer, look for myriad ways to expand the practice's footprint. They want Community Care to be available to patients for almost everything for which they don't need an inpatient stay, and that starts with being the patient's keeper of information.

"What we're trying to do is tier the primary care activity," Parikh says.

Other group practices are looking to develop ancillary services that complement their specialties, says Jon-David Deeson, a shareholder at Pershing Yoakley & Associates, PC, in Knoxville, TN. Those services used to be focused on reimbursed activities, like diagnostic imaging, but after reimbursement was dialed back recently, discretionary services—in other words, cash-based—are rising in importance.

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