5 Problems That Could Spoil Your Practice Merger

George Conomikes


February 27, 2013

In This Article

Shakeup at the Top

4. Undermining Physician Leadership

We've found that the best leadership lies with one person. Nevertheless, some merged practices have created a "shared leadership" of 2 or 3 physicians -- usually the heads of the merged practices. The result: This fuzzy leadership now requires several physicians to make decisions that could be more efficiently (and effectively) carried out by one.

One merged general surgery practice a couple of years ago had several physicians vying for the top spot. Eventually, they agreed to elect a single leader who would represent them in insurance-contract negotiations, recruitment efforts, and the like. To keep the former candidates engaged in the new practice, we designated them as "lieutenants," who separately oversaw personnel, finances, information systems, and marketing. These doctors then reported back to the "president" during a scheduled meeting once a month -- or sooner, informally, if they needed help with a decision. By all accounts, the system has worked very well, and the practice is growing.

5. Skimping on Information Systems

Today, most medical practices have implemented an electronic health record (EHR) system. In a merger, a safe, money-saving bet is to use the system of the larger practice, at least initially, since the new and bigger group is very likely going to need a new system. That's because simpler EHR systems focus only on medical records, billing and collections, and appointment scheduling. More advanced systems provide management information that pinpoints practice weaknesses that merit remedial actions.

Surveys of EHR systems from the health research firm KLAS show that the highest-ranked systems for small practices (1 to 3 physicians) don't show up on the list for practices with 10 or more doctors. We've found that larger practices need more data to make good decisions. This requires more sophisticated (and more costly) EHR systems than those needed by smaller practices.


Like a marriage between 2 people, a marriage of medical practices can be a bumpy ride in the first few years. But with patience, planning, trust, and communication, the new partnership can be more successful than any of the individual practices -- including their founding physicians, employees, and perhaps most important, their patients -- could have ever imagined.