BLOG: How to keep doctor workload, compensation and other squabbles from killing your group practice, part 2

ByJohn B. Pinto

This blog continues with part 2 of a four-part series on avoiding partnership conflicts.

How should decisions be made?

Few new partnership or corporate documents initially cover decision-making in sufficient detail, and require that the group fine-tune the rules over the years. In mature, amended agreements, there should be sufficient detail regarding how decisions are made to allow for unambiguous group and individual action. This fine-tuning should set down the decision and spending authorities of department heads, individual doctors, the administrator, the practice’s managing partner and the board itself. Subject (as always) to the recommendations of your legal advisor, board votes should be categorized into at least two varieties: “small” decisions (eg, decisions under $50,000 in annual impact) and “large” decisions (eg, decisions with a higher cost, or great potential impact, such as the removal of a partner). The former can be passed by a simple majority; the latter by a super-majority, for example, six out of nine votes.

If we develop a new building, optical or ASC, should we all own it? Equally?

As a guiding principle, I strongly urge clients to share all practice business opportunities with all partners, even if some partners are not as involved as others. For example, if a multi-subspecialty group practice has a pediatric ophthalmologist who will make scant use of a new ASC, this doctor should still have an opportunity to buy into the unit. Of course, in many circumstances there should be an opportunity, but not an obligation to partner in a new ancillary service. For example, it would be unreasonable for a group of doctors in their 40s to force a partner in his 60s to buy into a new office building. In some circumstances, it might also be unreasonable for the same doctors to force their younger partner who’s just starting out to help pay for an expensive piece of exotic new capital equipment. It may sometimes be better to simply put this speculative resource in a separate capital equipment leasing company and lease it back to the practice at market rates on a per-use basis.

What’s the best formula for how we get paid?

Every system under the sun has its proponents and detractors, from pure equal-split, to pure “eat-what-you-kill,” and everything in between. There are literally hundreds of models. Depending on the individual practice, at one moment in time, one methodology is usually better and fairer than the others. But check the same practice in a year, and odds are great that something will have changed to make the adopted system now less fair. That’s why I urge larger and more dynamic client practices to formally review their compensation formula at least annually...and meanwhile, to allow any doctors who think they’ve been put at a disadvantage to come to the board at any time for a more timely review.

How are new patients assigned to each of us? What are the boundaries, if any, on our personal scope of care?

I didn’t think about this topic much until years ago when I heard that one physician in a group practice was paying off the front desk staff to steer surgical patients his way. Your practice should have formal, written receptionist and phone staff rules for how patients are assigned. Your practice should also have significant group discussion and some formality when it comes to which doctors get to provide specific subspecialty services. My favored approach is to simply say, “Each optometrist and physician in our practice is allowed to provide any and all eye care services for which he is appropriately licensed and trained, subject to the oversight of the practice’s medical director and peer review.” Arrangements to shunt subspecialty care to only the doctors fellowship-trained in that discipline may leave the practice overly dependent on a single key subspecialist, and the other doctors blocked in their professional growth.

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams and a new book, Simple: The Inner Game of Ophthalmic Practice Success. He can be reached at pintoinc@aol.com; website: www.pintoinc.com.