Coaching practices to work like a team takes clear goals and a referee
Tackle issues head-on
You’ve heard the stories. Two physicians don’t see eye to eye on a management issue. Rather than talk it out, they each solicit support from other doctors in the practice and from the support staff. Before practice managers know it, they have two camps in their practice, and the disagreement starts affecting every aspect of the work — from efficiency to communication. And you, as a physician relations coordinator, are stuck in the middle. Is there any way to avoid such situations?Yes, say the experts, if you are willing to tackle the problems head-on before they take over your practice. "There are areas you find that you just can’t work out," admits Alan Chamberlain, CPA, executive director of the 13-physician Ohio Valley Heart Care cardiology and cardiovascular surgical practice in Evansville, IN. "That happens when the issue is personal — a lifestyle issue where the spouse and kids are involved. But if it isn’t personal, if it’s professional, you can resolve it."
Style over substance?
Chamberlain says most conflicts are matters of style, not substance. For example, his practice takes great pride in participating in events sponsored by its referring practices. Recently, one of his physicians — John Smith — was doing outreach in a community 30 miles away from his office. The practice had two new physicians starting and was holding a welcome party for them."I had built a good relationship with this practice, and I knew that this party was important," says Chamberlain. "I knew we needed to be seen there." But Smith didn’t want to go. Chamberlain tried to explain the importance of impressing referral sources, and reluctantly, the physician agreed to go to the party. While there, the two new physicians made their appreciation for Smith’s presence known.
"On the way home, Smith said he realized how much it mattered to this practice for us to be there," recalls Chamberlain. "It just clicked with him."
The best way to treat a problem between physicians is to treat it like they treat disease, says Richard Hoerl, PhD, president of the Denver medical consulting firm Hoerl & Associates. "First you diagnose, then you treat," says Hoerl. "Sit the doctors down and ask each what is wrong, then put the issues on the table and deal with them one by one."
Some issues are interpersonal, but even these can be handled with relative ease before things get ugly, Hoerl say. However, if it is a personal issue, you may want to invest in an outside consultant. "It can get very hot, and you might want to avoid being in the middle."
One practice with which he worked recently involved a group of physicians who had problems with one of their partners. "I sat them down and asked them each what one or two things they needed from this one doctor to make the practice run more smoothly. You find out the immediate needs and get it on the table."
Chamberlain says that while administrators can solve problems that are management or operations related, it’s best to let physicians deal with medical problems. But even there, the administrator can help by making suggestions that will help circumvent problems in the future.
For example, Ohio Valley Heart Care has started establishing clinical pathways for the top 20 to 25 codes. Physicians will have to work through the pathways and justify any deviations. That should be a significant step in eliminating clinical conflicts in the future, says Chamberlain.
Sometimes, there is no choice but to bring in lawyers. "Professional divorce can be the only answer in some cases," says Fred Schraeder, mid-south regional director for Advocates for Primary Care, an Oakland, CA, consulting firm with expertise in physician practice conflict resolution.
In his 21 years of administrating practices and 10 years as a consultant, Schraeder has seen doctor conflicts lead to a breakup of a practice many times. In some cases, the reasons are related to substance abuse. In other cases, it is because one doctor is having an extramarital affair with a staff member. "Sometimes it seems as if there is a crazy doc in every group," says Schraeder.
In cases where the problem is large and ugly, Schraeder says you should not be afraid to call in your lawyers and let them resolve the issues. "You may be spending up to $45,000 in legal fees," he says. "But at least you are salvaging part of the practice."
Schraeder says physician relations coordinators and administrators should listen to what their staff and physicians are telling them. They can often provide vital clues about when a problem is getting to be too much to handle yourself — when you need to bring in outside or legal help. "These things can come out of the blue," Schraeder says, "but sometimes you have warning. If you see something brewing, talk to your medical director, call a consultant, and at last resort, call a lawyer."
But a better way of dealing with problems is to avoid them altogether, says Hoerl. "Most of the problems I see come because there is no strategic plan or clear vision in a practice," he says. "If you don’t know where you are going, if you have no game plan, you are more likely to fight."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content