|Year : 2021 | Volume
| Issue : 3 | Page : 249-251
Group practice – A concept doctors are shifting to
Department of Ophthalmology, Aswini Hospital, Thrissur, Kerala, India
|Date of Submission||23-Aug-2021|
|Date of Decision||24-Aug-2021|
|Date of Acceptance||24-Aug-2021|
|Date of Web Publication||08-Dec-2021|
Dr. Babu Krishnakumar
Chinmaya Nadathara P O, Thrissur - 680 751, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishnakumar B. Group practice – A concept doctors are shifting to. Kerala J Ophthalmol 2021;33:249-51
Treating a patient began by a single doctor at his premises as solo practice. After long years of its prevalence, the concept of group practice is now emerging, considering its many advantages. Now, many doctors are in group practice as it is an effective approach to face the sprouting demands of a progressively complex health-care scenario. Group practice is implemented as two or more doctors practicing under one roof as a single establishment.
There are five types of medical practice all over the world.
| Solo Practice|| |
A single doctor treating his own patients at home or own/rented clinic with minimum support staff. This is also named as private practice. The advantages are individual freedom of treatment, maintenance of close relationship with patients, and liberty to set own working hours and holidays. New medical equipment can be purchased by the practitioner by choice for the growth of his practice. The disadvantages are long working hours, difficulty in availing long holidays as regular patients will suffer due to the practitioner's absence, and risks (financial or practice oriented) falling on the sole practitioner.
| Group Practice|| |
A group practice involves two or more doctors who all will deliver medical care within the same facility. Group practitioners may be from a single specialty or multi-specialties. A group practice is established by the partner doctors agreeing upon terms of sharing the staff, income, and facilities available. Combined responsibility makes group practice less stressful. They will have more working capital compared to a single individual investing. The working hours, absence, and holidaying are all managed among the partners. The main drawback is the need for a consensus among doctors on business decisions and shared income.
| Health Maintenance Organization|| |
The health maintenance organization (HMO) provides care only for their members and beneficiaries, for whom the association is formed. They will not treat an outside patient. It is aimed to reduce medical costs for their members. The two types of HMOs are staff model and group model. The benefits of employed doctors are stable work, regular hours, less regulatory responsibilities, regular salary, and bonus. Doctors working this way are disadvantaged with lack of autonomy and have to follow the organization's guidelines while treating a patient.
| Hospital Based|| |
A doctor is employed in a single- or multi-specialty hospital. The hospital will have a regular patient base and referral network. The advantages for a doctor in hospital-based practice are regular work schedule, low legal risk, and predictable income. The drawbacks are lack of autonomy and regulations of hospital committee.
| Locum Tenens|| |
In this modality, a doctor gets temporary employment at a specified place for a specified period. The salary may be high compared to permanent employment. The doctor employed in locum tenens is advantaged with schedule flexibility, variety, and different geographic locations. Regular transfer of working place, lack of steady work, and no additional benefits are the drawbacks.
| Group Practice|| |
Mayo Clinic, Rochester, Minnesota, USA, founded group practice in the late 1800s and is regarded as the father of group practice in medicine. Around 1932, there were 125 group practices. By 1980, group practice became a preferred model of practice in the USA. By 2011, group practice has become the accepted norm and main health-care system the world over.
Unity is strength transpires as the moto for group practice. Instead of a single mind, many minds work together for success here. The medical fraternity is gradually shifting from solo practice to group practice as this happens to be a safe mode of medical practice. The issues a solo practitioner faces are multiple such as complex government regulations, expensive instrumentation, and corporate entities buying up practices and patients. While conceding the autonomy, the doctor in a group practice gains many benefits. They combine different skilled doctors at the same working area so that the patient needs not to be referred to different hospitals for complete cure. A doctor in a group can afford to handle sophisticated, highly necessary, and costly equipment. Group practice can cover a wider area, work in multiple locations, deal with more patients, and can be more profitable. While working in a group, you will be benefited by regular feedback from peers and coworkers. There will be commitment to one's ethical duties to protect patients and avoid conflict of interests. They will be having full-time administrator and office staff to take care of patient appointment scheduling, cash handling, accounting, dealing with government regulations, and doing the ministerial work connected with hospital maintenance. Group practice can have advantageous negotiations with insurance companies to get higher reimbursement rates. The group will see that you will be having more time for yourself, your patients, and your family. There is less likelihood of burnout in a group. Financial transparency will be one of the attractive sides of group practice.Group practice will become a part of the health-care system in future too. Group practice seems to have more strengths than weaknesses.
[Table 1] depicts the pattern of types of medical practice.
|Table 1: Distribution of physicians by ownership status and type of practice (2021)|
Click here to view
Developing a group
Group can be of a single specialty or multi-specialties. The main formats of group practices are as follows:
- Partnership – registered or unregistered. Will have unlimited liability
- Limited liability partnership
- Corporate – private limited (2–200) or public limited (7 to unlimited)
The key issues to be planned after forming a group are as follows:
- Budgeting on preliminary expenses, fixed cost, operating cost, and availability of finance and its cost.
- Taxation like GST, income tax, asset purchase, foreign currency registration, and import/export code
- Human resource issues – ESI, PF, and other statutory obligations.
Group practice can be started in a rented building or own premises. For having own area, the group has to purchase the land at the government or local body specified area. Then, plan the building design for a hospital and get the license from the local body or government. The next important duty is planning the workforce in addition to the group of doctors. The most important part is to get an idea from different sources by different members of the group on planning and purchase of different medical equipment. There should be facility for Electronic Medical Record section to collect, preserve, and retrieve the patient data on health and in disease. In present-day circumstances, there should be ways to promote ethical health-care marketing. Different strategies such as professional referral marketing, internet marketing, internal marketing, external marketing, public relations, and branding are the ways established and successful groups resort to without crossing lines drawn by the Ethics of National Medical Commission.
The smooth running and success of a group practice depends on different factors and responsibilities of each member of the group. Due respect to everyone in the institution is a must. Learn from experienced sources on how to do and how not to do things. Be honest in your approach and do what benefits the entire group. Do not go for short-term benefits at the cost of others. Arrive at a partnership agreement and set rules of engagement of each partner. The group should have a written business plan. Select the most suitable doctor as a leader with another doctor as a leader in the wings to assist and learn from. Have frequent board meetings to form an opinion and support the decisions of board always. The group has to add the right doctors and facilitate a smooth exit for wrong doctors from the group. There should be no poaching of patients. Transparency in accounting makes sharing of profits easy. Allow each doctor to customize aspects such as consulting hours, holidays, vacation, and role in management of the institution or in research as far as possible. Build up camaraderie among the group by staying together, working together, playing together, and holidaying together.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kane CK, Emmons DW(2013) New Data on Physician Practice Arrangements: Private Practice Remains Strong Despite Shifts toward Hospital Employment. AMA23:1-16.