Current market trends in hospital/physician integration.

This article explores recent trends that are dramatically changing the landscape of typical hospital/physician integration models and provides the reader with useful insights to better evaluate this dynamically changing marketplace.

Better off alone? Why physicians don't merge.

The era of the small medical practice is over. How many times have we heard that? It was widely proclaimed back in the 90s, in the wake of the Clinton administration's healthcare reform proposal. But 15 years have passed, and there are stillplenty of physicians working in solo and small group practices. Despite all the predictions that small practices could not survive in an environment of "big healthcare," they persist. A report published recently by the U.S. Centers for Disease Control and Prevention estimated that as of 2003-2004 more than 35% of office-based physicians were in solo practice, and roughly 66% practiced in groups of five or fewer. This article examines why, in spite of the challenges of being in solo and small group practices, many physicians still prefer the status quo and resist forming or joining larger groups.

Physician mentoring and evaluation.

Maintaining a cohesive medical group requires more than partners who get along with one another. Physicians must share the same values and be willing to give (and graciously receive) honest feedback on issues such as quality of care, technical competence, patient- and staff relations, behavior, work ethic, and productivity. This article shows group leaders how to start this process by mentoring new physicians and how to then extend the process to include all physicians in the group. Medical practices that have evaluation systems in place enjoy benefits that include better communication, accountability, increased retention rates, and a more unified group. Many physician groups avoid the evaluation process because they are not comfortable "judging" their peers, they don't know how to approach the process, or they don't want to invest the time. This article presents alternative approaches to establishing a mentoring and evaluation process, shows group leaders how to identify which is right for them, and provides do's and don'ts for a smooth implementation ofthe process.

Disruptive physicians...and how to deal with them.

Physician behavioral issues take a toll on medical groups, and practice leaders often lack the basic tools to address them. All too often, medical practice leaders and administrators look the other way when physicians are disruptive or behave inappropriately. They delay dealing with negative conduct for a variety of reasons and allow physicians to continue to act out in ways that would never be tolerated in a staff member. Much has been written about how to deal with serious issues in physician behavior, such as impairment and addiction. This article addresses how to recognize and manage less extreme and more chronic disruptive behaviors. It provldes the reader with comprehensive tools to identify and address these issues, including a "do and don't" list and a simple five-question test to assess in an unbiased way what steps should be taken.