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Group Practice in
Ophthalmology
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Vidushi Sharma MD, FRCS,
Suresh K Pandey MS
- Suvi Eye Hospital & Research
Centre
Kota, Rajasthan
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In recent years, Group Practice has
become a concept, that is often talked about, and everyone seems
to wax eloquent on how good and useful Group Practice can be for
all involved. And yet, there are very few examples of a really
successful group practice, where the stakeholders are all happy
and the association can last for a long time. So, what is it
about Group Practice that makes it an idea, “easier discussed
than implemented”? Why is it that the list of perceived
advantages of Group Practice is so long, and yet there are few
models in practice, from which beginners can take
inspiration and follow their example? Or is it that
ophthalmologists are simply not suited for the concept? And aft
er all, why make the change from Solo to Group practice, when
solo practices have survived and done well for years? The reason
why we need to discuss all this is because our society, medical
science, the nature of practices and everything else around us
is changing so fast, that we need to respond equally fast to
these changes and evolve new methods of keeping up. While it was
alright till even 2-3 decades ago to take things easy, and a
reasonable level of competence was enough for a doctor to
survive and do well in society, with adequate financial
remuneration and lot of respect; today the scenario has changed
dramatically.It is still a matter of individual choice and
personality to take things easy or not, but we now live in a
very demanding society, with constant pressure to do more, be
more and give more and there is ever increasing competition. Our
role models are all ophthalmologists, who strived hard and
achieved tremendous financial success and acclaim; and to
achieve even a fraction of that today, needs a lot more hard
work and varied skills to establish and run a successful
ophthalmic practice. For doctors, the real need of the hour is
to somehow become more efficient and achieve more (more
technology, more expertise, more volumes, more attractive
workplace) with less (less time, less staff and less
money) and the need of the hour for the society is to contain
the spirally rising costs of medical treatment. It would also be
in the interest of ophthalmologists and doctors in general to
try and
evolve new models to contain medical costs, before we are forced
to do so by society and government. |
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Group Practice Vs Solo Practice
Where does the concept of Group Practice stand amidst all this?
The advocates of Group Practice consider this as one of the best
methods to contain costs and increase efficiency of doctors,
allowing them more personal time. Most certainly, it is obvious
that if a group of doctors can share the same equipment and
staff and expert managerial assistance, the costs would come
down dramatically and this arrangement would also allow doctors
more flexibility in their daily work schedules. This would also
make the group of doctors more strong in society and give them
better negotiating power when dealing with diverse elements like
insurance companies, organizations for empanelment, civic
agencies, medical equipment manufacturing companies etc. This
would also protect them from unwanted elements like
blackmailers, corrupt officials etc. who unfortunately make
doctors a soft target. This could theoretically become a win-win
situation for all – the doctors in the group as well as their
patients. On the other hand, there are definite advantages to
Solo practice. Though it may seem less glamorous and more
outdated to see a single doctor managing everything in a small,
unassuming setup, but it really suits those who like to make
their own decisions and chart their own course. You can decide
your own timings; your own direction for future growth, work at
your own pace and the money you make is all yours. Your only
arguments are with your spouse and there is no need to have
endless discussions about revenue sharing etc. And then, there
are many examples of individual ophthalmologists, who have
single-handedly earned more name as well as money than even
large institutions. The key therefore is to choose the right
option for yourself. It is unwarranted to have a debate over
whether Group Practice is better than Solo Practice or vice
versa, but to choose what suits you best. Whether for solo or
for group, it is imperative to have clear objectives and goals
beforehand and chart your course accordingly. At the same time
it is equally important to be honest to yourself as well as your
colleagues. For example, it is perfectly legitimate for a
beginner to join a group practice for few years, before starting
a solo practice, to gain experience and earn some start-up
money. But it would be best to be clear about this course and
let the colleagues in the group know about your future plans. At
the same time, the group should also honestly make it clear
tothe new entrant about the kind of responsibilities and job
profile. |
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Pros and Cons of Group Practice
Let us also have a closer look at some of the perceived
advantages and disadvantages of Group Practice. For example, one
of the most oft en cited advantage of Group Practice is sharing
the cost of medical equipment, bringing down the start-up cost.
Now, a beginner Solo Ophthalmologist, basically starts with a
phaco set-up and expands along the way as the earnings increase.
So, he/she would need about 25-30 lakh rupees for a good
operating microscope, phaco machine, A-scan, slit lamp, OPD
instruments etc. On the other hand, a group practice would
usually be with members taking interest in different
sub-specialties, which would need about 2-3 crore rupees,
if the set-up for all sub-specialties is included. If this is
shared among say 5 people, it would give
a cost of 40-50 lakhs per person. Of course, it is possible to
have a group start only with phaco set-up, but it would be most
impractical in a new set-up for all group members to focus only
on
cataracts in a limited base of initial patients. While, there
may be many variations to the basic concept of group practice
and these examples may not be universally true, but this applies
to most situations. Also, the idea of having more flexible
schedules and personal time generally isn’t true, for the amount
of work increases as the size of practice increases and also
because of heightened patient demands. However, the system of
Group Practice certainly allows for some leeway in situations
like illness, personal functions etc., without breaking the
patient chain, unlike in a Solo Practice. In a nutshell, Group
Practice is not so much about making quick money with minimal
investment, even while working less and having more free time,
but is more about achieving a broader vision and being able to
do better quality work with cutting edge technology. The
patients are also benefited as all sub-specialties and
cross-opinions are available under the same roof. The patient
care improves and the cost to the patient also comes down in
some situations, not to forget situations like the dreaded
nucleus drop, which can be immediately taken care of. This kind
of group also attracts more patients, because it looks bigger
and better and raises lesser doubts among patients. Group
Practice remains an elusive goal, which everyone wants to
achieve, but is mostly out of reach. The most common reason for
this failure is inability among the members to share a common
vision. And that is the reason why Group Practice will always be
a difficult to achieve utopian ideal, for it is impossible for
any 2-3 or 4 people to agree on everything for a long time.
Differences of opinion are bound to arise, egos are going to be
ruffled,financial matters will become more and more touchy as
the revenues increase; and that is perfect recipe for divorce.
So, are ophthalmologists not suited for this concept and should
give it up? No, but make sure you find the right partners for
your group. Discuss your goals and priorities very clearly
before associating rather than somehow roping in people to
provide capital and then realizing that everyone is moving in a
different direction. Also, there doesn’t have to be a set
pattern for Group Practice. There can be many variations on the
basic theme of sharing expenses, administrative duties and
financial returns, based on the unique requirements of your
practice setting. For example, in a big city, it is possible to
have independent OPD set-ups in different parts of the city and
share a common operating facility. In a smaller city, it is
possible to have some mobile equipments, which can be shared on
a rotatory basis with someone being independently responsible
for maintenance. The most important requirement for any
arrangement to be successful is of course, HONESTY and
trying to avoid any one up-man ship. But ophthalmology being so
competitive, one up-man ship can be avoided only if there are
very rational and acceptable models for revenue sharing. It is a
good idea to have revenue sharing based on share in capital as
well as individual productivity. It is extremely important to
remember that perfect equality is a myth and there is no such
thing as a 50-50 partnership. It is just like marriage where you
must “keep your eyes wide open before marriage and half shut
afterwards”. Oft en, it is a rewarding exercise to stop
comparing your deal with your
colleague’s deal and compare instead with what you would achieve
if you went Solo. In practices, with members belonging to
different age groups, there must be some acceptance for change
in opinions that comes with age as well as changed training etc.
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Conclusion
If we can learn to live with our small differences and
inequalities and enjoy variety, we must try to form groups with
clear and well-discussed goals. If not, there is absolutely
nothing wrong in going Solo and singing your own tune, for a
group is worthwhile only if it can deliver a coordinated
jugalbandi rather than an uncoordinated cacophony.
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 First Author
Vidushi Sharma MD, FRCS |
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