How to get your group practice on the same page

According to Elizabeth G. Serrage, MD, there are at least three different models for managing group practices:

The family living model can be the most difficult to negotiate, but offers a plethora of rewards in the long run, said Dr. Serrage, who works with five other ophthalmologists and an optometrist at Eyecare Medical Group in Portland, ME. The practice also employs an executive director.

She advocated hiring a good facilitator who can use psychological tests to help members of the group identify similarities and differences in the way each person processes information. Armed with this knowledge, co-workers can better understand each other, she said.

"Keep in mind that our differences afford us the greatest opportunity for building a more effective team, but they also lead to conflict," Dr. Serrage said. "In our group we have a variety of personality types, interests, and ages, and each is quite certain that his or her view of any matter is the correct one. We often have a collision of multiple realities."

To keep those collisions from becoming destructive, the group holds meetings with mid-level managers every other Monday to discuss basic operations. In a crisis, the group has included a facilitator to help work out a solution.

In addition, since 1985, the group has held quarterly, day-and-a-half-long retreats at a nearby hotel with its psychologist/facilitator.

The retreats begin by letting each person discuss his or her situation within the practice. Then, the group sets an agenda of topics, such as operating room anesthesia procedures, refractive surgery marketing, whether to purchase new equipment, staff morale, competition, growth opportunities, interpersonal relationships, and so on.

"As we move into discussion, we seek to recognize the differences, listen and learn, and see that everyone participates," she said. "We identify conflicts as they occur and seek to resolve them when possible. This is not easy. And when you're the one involved in a conflict, it's even harder. But we've learned it's worth all the effort."

The group has used these retreats to work through personal and professional problems, including divorce and financial issues. The result has been a greater understanding of each other's contributions to the whole.

By combining biweekly and quarterly meetings, the group is able to address and resolve problems before they loom too large. Time and experience have made these meetings more productive, she said. The group also has planned "fun" retreats on a nearby island, where little business is discussed.

"We have learned to value diversity and be curious about each other, to move toward rather than away from each other when there is a potential for conflict," Dr. Serrage said. "We've learned that looking at both sides carefully we can look at the beauty and the similarity, as well as the conflict."