The Achilles Heel of Group Practices

Kenneth J. Terry, MA


August 18, 2011

In This Article


Harveen Singh, a solo family physician in Framingham, Massachusetts, used to work for a large hospital-owned practice in Florida. It was not a happy experience.

"It was all about numbers," she recalls. "We were expected to see a minimum of 25 patients a day just to break even on our salaries. They really wanted you to see 30-32 patients a day. Some people did, some did not. It was quite a stretch -- you almost felt like a little worker bee."

Singh always sensed that management was watching her and evaluating her performance. "If a patient had more than one issue, you didn't dare take an extra 2 minutes with that person, because your eyes were constantly on the clock," she says. "The administration would have monthly meetings and give you your numbers and tell you how many patients you saw and how much money you generated and what was expected. And they'd always attach your bottom line."

After 18 months, Singh had had enough. She quit the hospital group and 6 months later opened her own office in Framingham. Since then, she has built a practice that now includes nearly 2500 patients. With the help of an electronic health record, she says, her office has become very efficient, and she has enough time to provide the proper amount of care to each patient. "I have all the time in the world to follow up."

Doctors Do Not "Play Well" Together

Some doctors are not well suited to working in groups. The real Achilles heel of group practice, say practice management consultants, is that many physicians simply do not know how or do not really want to get along with their colleagues.

"When doctors come out of residency, they are a self- and environmentally-selected group of individualists who have been highly competitive with their peers," notes Keith Borglum, a consultant in Santa Rosa, California. "Because of these factors of selection, doctors often don’t play as well with others as people who go into other fields."

Kenneth Hertz, a principal with Medical Group Management Association Consulting in Englewood, Colorado, concurs. "Doctors have gotten to where they are essentially on their own. Not many doctors look at this whole team of people and say, 'they helped me get to where I am.' So we talk a lot about doctors not playing well with other people -- and it really is true. It’s really out there."