Group Practise For Specialists in Private Practise 

Group Practise For Specialists in Private Practise

A specialist working in a public hospital recently asked me to write an article on the benefits and drawbacks of joining a group practice. I had actually been thinking about this subject for a while. I  approached a group of anaesthetists, working in  a group practice with the intention of interviewing one of them. but they politely declined. Here, I’ll share my personal viewpoint on this subject.

Benefits of a Solo Private Specialist

I’ve always worked as a solo private practitioner. I am well aware of the benefits and drawbacks of solo practice. The benefits include: I am my own boss. I choose when to report to work, how hard to work, and when to take time off. I have no one to answer to. That freedom is nice. I can hire anyone I want and purchase any item I desire. I have expensive taste when it comes to buying medical equipment. I have bought the best machines to assist me in my work. This includes ultrasound machines, laparoscopic surgery equipment and even new technology such as HIFU. Whether these investments succeed or fail,  is entirely up to me.

Drawbacks of Being A Solo Private Specialist

What  are the drawbacks of being in such a practice?

Firstly, throughout my professional career, I have not been able to take a lot of time off work. Secondly, some of  my equipment,  while not losing money, can still be used more effectively if more than one person uses it. This is resource waste. Patients are also complaining that the wait times at my clinic , as well as seeking appointments with  me are getting longer as I get busier. I need to reduce the number of patients I see at my clinic in order to handle the multitude of tasks that I do, which include providing obstetric care, IVF, laparoscopic surgery, and now HIFU.

Types of Group Practices

Group Practice among Anaesthetists

Group practices come in a number of varieties. Let’s focus on group practise among medical specialists in private practice. As far as I know, Malaysia’s first specialised group practice comprised anaesthetists.  Anesthesia services were provided to local surgeons by a group of anesthesiologists in a given town. I was aware of this practice in Melaka when I initially arrived in this town, as well as in Johor Bahru where I worked as a registrar.. As most anaesthetists offer the same services, namely anaesthesia; and since patients typically do not request for a specific anaesthetist, organising this is rather simple. This service can be offered by any member of the group. Typically, a number of local anaesthetists will work together to offer the service to private medical facilities like maternity homes or small hospitals that are owned by individual doctors. As one anaesthetist cannot cover all of these small centres, they band together to offer anaesthesia services to all of these facilities. They benefit from this, as do the small centres that do not have to hire their own anesthesiologist. They each receive an equal share of the income. Being a member of this organisation has advantages for the anaesthetist as well, as they can take time off and continue to make money. Additionally, even when ill, a person can still benefit from the labour of their team to generate money. It offers the group a safety net.

This kind of group practise among anesthesiologists  also operates in private hospitals. Most hospital administrators don’t care whether an anaesthetist works in a group or alone,  as long as the service is rendered. When the team has to be expanded, an issue occurs. Who makes the choice to add a new team member, and when is that decision made? How will the team integrate the new anesthesiologist? The main concern will be how will this new anesthesiologist get paid. Typically, senior anaesthetists will set the rules. The new anesthesiologist might be coerced into taking on all the challenging and protracted cases. Additionally, he/she might receive a lower income than the senior anaesthetists based on a fixed starting wage or even a percentage taken from her pay to feed the group’s senior partners. This is a drawback for group practice, particularly because private hospitals are usually glad to hire additional anesthesiologists to support their surgeons. As such,  group practice teams are no longer present in the majority of private hospitals in Malaysia because hospital management wants to be in control of how many anaesthesiologists work for them or who will fill that position. The norm now is for a private hospital, while maybe in consultation with the resident anaesthetist,  to take a new anaesthetist to add to the existing number. The cases are often distributed among all anesthesiologists, including the new one. The winner may be the new anaesthetis who may receive an equal share of the cake. As I previously stated, this is simple because patients typically do not look for their own anesthesiologists.

Group Practice among Obstetricians and Gynaecologists

Let’s now look at other groups of specialists. One group of Obstetricians and Gynaecologists that I am aware of,  collaborated in one of the  private hospitals  in Ipoh. They work together and do not want patients to pick which Obstetrician they will see. The patient will be seen by whomever is at the clinic, and a patient will be seen at least once by all the Obstetricians throughout their pregnancy so that any one of them can conduct the delivery. Such group practice has its benefits and drawbacks for both the doctor and the patient.

The benefit of working in a group like this for the doctor is that he may take the following day off and recuperate, when he is on call and delivers babies late at night or early in the morning. He is not required to work if he is exhausted. In order to avoid operating while fatigued, he can schedule his elective procedures so that they do not take place the day after he is on call. He can go on vacation while the practise is still going on. Another benefit is that each partner can specialise in a certain area, and by referring patients to other members of the group, the patient is not lost. When in challenging situations, one doctor can call for help from another in the group.

The drawback is that in order to avoid disparities in patient management, the group must develop equivalent patient management strategies. The group must also be allowed to inform a patient who requests individualised care that they will not accept it. One issue is that it will be challenging to kick someone out of the group if they start acting inefficiently, lazily, or incompetently. Before the group begins, it is important to thoroughly plan out the details of what will happen if one of the members has an illness or perhaps passes away.

In a group practise, the patient has the benefit of constantly having a fresh doctor treating her, whether she is in the antenatal clinic, the delivery room, or at surgery. Additionally, the clinic is better managed because a doctor will be there to consult patients rather than being called away to the delivery room or operation room. Therefore, there won’t be a long wait at the clinic.

A group of Obstetricians and Gynaecologists in Singapore even went so far as to corporately organise themselves and list their services on the stock exchange. They denied my request for an interview so that I might understand more about their experience. This model, in which experts in the same field working in various hospitals form a group practise and recommend patients to one another or even aid one another in difficult circumstances; may be another choice for specialists in Malaysia. The problem will be getting the hospitals where they work,  to accept this type of arrangement. All the doctors in the group must be given practising rights at each hospital, and we know that this is difficult in the highly competitive environment in which hospitals work in this country.

Other Group Practice Models

Another model of group practise is having specialists from different specialties form a group practice.. This may involve a group of gastroenterologists taking in a colorectal surgeon to work with them or a group of colorectal surgeons taking on a gastroenterologist. It may also be a gynaecologist, colorectal surgeon, and urologist working as a team together. The problem will always be, how to share the income. The arrangement could be a loose one where they help each other or a strong one where they are obliged to refer to each other and share the income. Each has its own advantages and disadvantages. One such group is Chengild G. I. Medical Centre, a small hospital with a gastroenterologist, a colorectal surgeon, and others who started a small hospital and have listed themselves.

Cracks in a group practise occur when there is a crisis. The biggest crisis will be if there is a medico-legal issue whereby a patient sues one doctor. Who is going to take the liability? The doctor or the group? Another crisis will arise if the patient does not pay her bill or the bill overruns and she asks for a discount. These issues have to be discussed prior to forming the group.

Here I will summarize generally, the advantages and disadvantages of group practice. 

Advantages of Group Practice

1. Shared workload and responsibilities

One advantage of a group practice is that it allows for the sharing of workload and responsibilities among specialists, leading to improved efficiency, productivity, and teamwork. This can ease the burden on individual doctors and improve patient care by reducing wait times and increasing access to care.

2. Greater availability and access to medical care for patients

Group practices offer greater availability and access to medical care for patients through extended hours, weekend or evening appointments, at multiple locations.

3. Improved communication and collaboration among specialists

Group practices offer improved communication and collaboration among specialists, leading to better patient care and a more efficient healthcare system through sharing information and coordinating care.

4. Opportunity for professional development and growth

Group practices offer opportunities for professional development and growth through learning from colleagues, continuing education, and potential leadership and management opportunities.

5. Increased financial stability and bargaining power

Group practices provide increased financial stability and bargaining power through a larger patient base and additional benefits such as earning while on leave or sick leave. They can also take out insurance policies to cover each other’s death or disability so that the practice can still continue with the welfare of the doctors’ families taken care of.

Disadvantages of Group Practice

1. Complex decision-making process

One disadvantage of group practice is its complex decision-making process, which leads to delays and difficulties in reaching consensus among multiple healthcare professionals, potentially hindering individual members’ ability to advocate for patients and leading to a sense of disempowerment or lack of control.

 

2. Potential conflicts of interest or personality clashes among specialists

Another disadvantage of group practice is the potential for conflicts of interest or personality clashes among specialists, which can lead to conflicts, misunderstandings, and tension within the group if members are unable to communicate and collaborate effectively.

3. Difficulty in maintaining a cohesive group culture

Maintaining a cohesive group culture, which is important for fostering teamwork and collaboration and leading to better patient care, can lead to a negative work environment and affect patient care if members are unable to work effectively together.

4. Increased overhead and administrative costs

Increased overhead and administrative costs due to multiple locations, additional staff, and increased administrative tasks can negatively impact the financial stability of the practice.

5. Potential loss of independence for individual specialists

A potential loss of independence for individual specialists is another disadvantage of a group practice. In a group practice, individual specialists may have to give up some of their autonomy and decision-making power in order to work effectively as part of the group. This can be challenging for some professionals, as they may feel that they are not able to make decisions or advocate for their patients in the same way that they could as an individual practitioner. In addition, individual specialists may feel that they are not able to fully express their personality or personal brand within the group practice, as they may be required to conform to the group’s culture and practises. This can be frustrating for some professionals and may lead to a sense of loss of individuality.

Conclusion

There are several factors to consider when deciding whether to join or form a group practice. Here are a few key factors to consider:

  1. Your goals and priorities: It is important to consider whether a group practise aligns with your goals and priorities. For example, if you value independence and autonomy, you may prefer to work in an individual practice rather than a group practice.
  2. Your patient population: Consider whether a group practice would be a good fit for your patient population. For example, if you work with a lot of complex cases that require the expertise of multiple specialists, a group practice may be a good fit.
  3. Your colleagues: If you are considering joining a group practice, it is important to consider the other members of the group. Are they professionals you enjoy working with and respect? Are their goals and values compatible with yours?
  4. Financial considerations: Group practices typically have higher overhead costs than individual practices, so it is important to carefully consider the financial implications of joining or forming a group practice.
  5. Administrative responsibilities: Group practices typically have additional administrative responsibilities, such as managing the schedules of multiple healthcare professionals and coordinating care between specialists. Consider whether you are willing and able to take on these additional responsibilities.

So what advice can I give doctors thinking of joining a group practice?

  1. Read the contract. I think it is very important to know what you are getting into. You need to cover all aspects of your working life within the group so that everything is clear before you join the group. After joining the group, you shouldn’t feel like you’ve been taken advantage of. Read the exit strategy and escape clause carefully in case you want to leave the group.
  2. Have good communication with your partners. Meet often and discuss problems so that all of you are clear on your future goals.
  3. Adopt a give-and-take mindset. Working alone is good because you are answerable only to yourself. Here, you are answerable to the group, and that can sometimes be difficult.

Selva

15/1/2023

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Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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