Try a corporate model committee structure
Small executive committees work for this group
When the Orlando (FL) Heart Center grew to eight physicians about six years ago, the group began to experience significant delays in decision making. "It just got to be too cumbersome for all of the physicians to agree on a single strategy," says Deborah Chandler, MBA, chief executive officer for the 16-physician practice. "There were just too many doctors."
The solution was not a traditional committee structure where each physician took on a particular committee (see related story, p. 97) but rather an organization modeled after larger corporate entities. The practice decided to elect a four-physician executive committee, which would in turn elect a managing partner. Those physicians would effectively run the practice, making recommendations to the board, which was made up of all of the partners.
Chandler says the organization has worked well for the group, allowing decisions to be made much more quickly. "We tried the general committee structure before we came to this decision," she recalls. "But we found that the physicians were not trained managers, and the decisions didn’t always work. There was a lack of people management skills in many cases."
The newer system has several benefits, Chandler says.
1. The physicians with the most skills run the practice.
Chandler says under the old system, every physician had an administrative role. That didn’t work. The corporate structure allows the four physicians who have the most to offer the practice in the administrative functions to take on the role of researching problems and making recommendations to the board. For instance, the physicians who know the most about managed care contract negotiations or who have more personnel management experience are more likely to be elected into the committee positions, Chandler says. They, in turn, use their skills to choose the person from the practice with the best skills to serve as managing partner. "[This physician] represents the practice in the community," she explains.
2. More time for medicine.
More of the physicians are free to spend their time practicing medicine under this system, she says. Rather than every physician spending some portion of time running the practice, that number is limited to five the executive committee and the managing partner of the 16 doctors. "The physicians should be taking care of patients. That is their view, and I agree."
3. It builds trust among partners.
For many practices, putting physicians in charge of the business leads to disagreements between physicians. This structure, says Chandler, allows the doctors to choose those they have the most confidence in to run each of the three locations of the practice.
In the six years the committee has been in place, there has been relatively little turnover in leadership. "Mostly, the same people serve, although our rules do allow for change if one person doesn’t work out," she says.
She advises practices who are considering her structure to make sure that the physicians who are likely to be put in charge of running the practice have a demonstrated knowledge of managed care, an interest in building the practice, and an ability to represent the practice in the community. "You have to know your business community to grow your business," she says.
Physicians interested in taking on a management function must also understand the time involved in doing so. In her practice, the managing partner spends about 15% of his time on administrative functions and 85% with patients. "If you have a very large practice, you probably need to have a full-time managing partner," she warns. "You have to make sure your practice understands that you can’t run a business on your lunch hour."
Remember, too, that you will have to pay your physicians extra for their efforts. Her committee members get a set stipend for their work, while the managing partner gets four times that amount. "It is for the productivity pay they lose by not practicing as much and to make up for the time they spend in night meetings."
In deciding whether this structure is right for you, Chandler says you should be sure to ask your physicians straight out how much involvement they want in running their practices. "Some will want to be very involved," she says. "Others may only be interested in some aspects of business management."
In the latter case, you can always create ad hoc committees to look at specific issues such as hiring a new physician or signing a specific contract. "We have one committee now which is looking at how to handle [being on] call," she explains. "As our practice grows, there is more call, and more physicians are involved in that discussion than just the four committee members."
For Orlando Heart Center, the executive structure has worked very well. "In our specialty, there are always emergencies. We had to find a way to make quick decisions and still limit the number of physicians who were involved. This is what we found works."
• Bette Waddington, CMPE, Consultant, MGMA Management Consultants, Englewood, CO. Telephone: (303) 697-5216.
• Page Sturgill, Director of Marketing, Orlando (FL) Orthopedics. Telephone: (407) 425-1556.
• Deborah Chandler, MBA, Chief Executive Officer, Orlando (FL) Heart Center. Telephone: (407) 246-8555.
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