The Achilles Heel of Group Practices

Kenneth J. Terry, MA


August 18, 2011

In This Article

Intergenerational Conflict

Both male and female physicians of the younger generation expect to have a life outside of work, and many do not want to put in the hours that older doctors are used to. This can produce conflict, especially in practices that still have equal income division.

"We have 2 older physicians who are at the end of their careers and we have 4 younger physicians at the start or in the first quarter of their careers," notes one doctor. "The older doctors in the past worked more hours, did more procedures, referred out less, and at the end of the day they split the earnings equally. They figured everyone was putting in the same effort.

"Our young guns now expect a more 9 to 5 existence. Income is less important than quality of life issues (less call time and more vacation). [They] do far fewer procedures and send most issues to specialists for management. Getting these 2 groups to work together on some issues can be a challenge," he says.

When "Call" Is a 4-Letter Word

Although there may be an issue with senior physicians laying back on call duty, Mayse says that junior partners are more likely to challenge them on that than in the past. A bigger problem is the need to see patients of other physicians when on call.

"Everybody has a different practice style," Schutte observes. "Some doctors want to know their patients intimately and all the details of their case. Other physicians are just dealing with the situation in front of them right now. For those who want to have a thorough knowledge of their patients, it's more difficult when you get a random call and it is somebody you don't know."

For some physicians, this is an issue of fairness. In a Medscape forum, for instance, a group practice physician said he practiced full time, but his colleagues all worked part time. "That means on the days that the other primary care physicians are out of office, I often get stuck with their last minute drug refills, laboratory orders, and controlled substances refills. To add insult to injury, one of the older physicians will hand me the charts of the patients that I refill medications for in his absence, despite the fact that he has been treating them for 25 years and I have never laid eyes on the patient."

Of course, doctors in solo practice also may share call with other physicians in a call group. But Harveen Singh does not share call, on principle. "Call groups are the same as group practices -- you are handling somebody else's bad decisions," she says.

The intense individualism of Singh is typical of physicians, which explains why so many of them have a hard time working together. "In medicine, there are less joiners than in other fields," says Borglum. "That is one reason why many doctors are less happy in big groups. And the bigger the group, the less personal it is."