Some of the best things about being in a group practice are getting the economy of scale, the relatively standardized policies and procedures and having enough staff to handle many of the administrative tasks than can so readily take away from a physician’s time – their most precious commodity.
On the other hand, the large group and its demand for uniformity can lead many a physician to feel that they are giving up their autonomy and many of the reasons that they went into the medical field. Balancing the needs of consistency for the group and maintaining the sense of autonomy for the physicians can be a constant battle. Through the past years, I have developed a few different ways to enhance the autonomy of the doctors without sacrificing the needs of the group.
Individual notification of information is one of the ways that I have been able to foster the feelings of autonomy in a group. As much as possible, I try to notify major events, news, policy changes, etc. individually to each doctor instead of by group memo or email. This may be difficult according to your group size, but I have found that by giving individual notification, I can sense each doctor’s personal reaction and opinion on a subject. Often I will get feedback at that moment that allows the doctor at a minimum vent on the subject, or they may be able to give meaningful comments that allow the event/subject to be structured more favorably within the confines of the group’s needs.
Inclusiveness is another way that I try to give the physicians a sense of autonomy. There are many things that need physician input and information in the operation of your practice. Look for those things and include physicians who feel that they don’t have much say or control in things. Give them projects to do in addition to their normal duties and they will gain meaningful input into the practice. For example, we have a protocol book for treating high risk OB patients. We periodically will split up the disease / symptom states between some of the doctors and let them research the newest journals/publications on the subject and report back to the group. With their research and group discussion, we develop protocols based on that physician’s research and direct work.
I have also been able to give the physicians a sense of more individual control by noting the policies/procedures in the office that can be individualized within their work area and allowing them the freedom to adjust these policies/procedures to their preferences. One of these areas where this has worked is through the direct supervision of their nurse/MA. Often, they as a team can come to realize the best work flow that will compliment their strengths and weaknesses and allow them to work their patient flow, Rx requests, phone calls, schedules, etc. on their individual level instead of a workflow designed to fit every work team in the office. Another thing that we allow is for a doctor to set their schedule template as to where they want to see what types of patient problems, physicals, procedures and the like.
The other way that I allow the physicians to gain a sense of autonomy is in the planning of our group meetings. I include the doctors in building the agenda and give them a voice in the meetings. I keep a Word file open on my desktop entitled “Future Agenda Items” and add to the list as the month goes by to gain input into the agenda items. The proposed agenda is distributed to the doctors usually a week prior to the meetings and I have the physicians lead in the part of the agenda that concerns items that they have suggested or want to discuss.
It is a constant work in process to keep the feelings of autonomy for our medical staff, but the work is rewarding although quite challenging. It allows for creativity on my part, cooperation on their part and the foresight to realize the elements in a group practice that have to be uniform, while identifying those elements that allow for flexibility and foster autonomy for the physicians.