Deciding who decides: How practices get governed

Help protect your practice from organizational and financial chaos by setting up who's running things and determining how leaders will be chosen.

By Larry Stevens, AMNews correspondent. Nov. 11, 2002.

A few years ago, Unifour Anesthesia Associates in Hickory, N.C., which had 10 doctors at the time, was having trouble making decisions. The group had a democratic, one-person, one-vote structure. But all decisions had to be approved by the group as a whole.

Because of this, "our meetings were interminable," remembers anesthesiologist Bruce Stevens, MD. Dr. Stevens says everyone felt the need to voice an opinion on each issue; so discussions tended to be long-winded, repetitive and circuitous. And even when a decision was finally made, the issue might surface again at the next meeting.

Will Latham, president of Latham Consulting Group, headquartered in Charlotte, N.C., says many groups have governance problems because of a mismatch between physician training and temperament and the requirements of group decision-making. Physicians normally work independently, but for many doctors, the overall structure in which they do so is a group.

"How do you walk out of an office where you're the primary or even sole decision-maker to a meeting where you're one of many?" Latham says.

The answer to that question, experts and physicians say, is by creating a structure that makes clear who's making the decisions and how they get made. That structure may vary by each group, but not having one may lead to organizational inertia that could hurt a group's morale and perhaps its financial health.

Symptoms of governance problems include difficulty or inability to make decisions, lack of support or even open sabotage by some doctors for decisions made, and backbiting and resentment on the part of some members of the group toward others. If untreated, the problem can result in group paralysis, reduced income or even dissolution. [...]