Question

Discuss the role of physician and administrative leadership in successfully managing a solo or group practice. Address the role of such leaders on patients, physicians, staff and the practice itself in improving all types of work. Discuss the role of an administrator, medical/clinical lead, nursing lead, as it relates to the operations of a practice. Discuss the differences between a faculty practice, an article 28 practice, a resident, Medicaid “clinic”, as it relates to leadership structures, reimbursement, and practice structure. (Leadership, Mission, Vision, Value, Operations, Management)  

subject physician practice management

Answer 1

The roles and responsibilities of physicians in group practice should be determined by a clear governance

structure. The group's organizationa chart should include everyone working in the group and should be understood by everyone in the group. In the real world, this rarely occurs. In the real world, physicians and their employees develop relationships and responsi-bilities that defy logic or explanation.

Many group practices have grown over time from solo or partnership arrangements, adding doctors, merging groups or acquiring practices along the way. This results in an organi-zation, which is almost unplottable on an organizational chart. This is why you will find groups with a seasoned nurse who knows where
to get nametags and a semi-retired secretary who knows how to call the right plumber.

A newly-hired practice manager has the opportunity to look with fresh eyes at the existing group structure, and to ask obvious questions about the rationale for existing systems.A veteran manager may have a more
difficult time defining the parameters of business operations within the group. In either case, it's important to determine where responsibilities lie. Physicians and managers must agree on who is ultimately responsible for making decisions, implementing operational changes and the overall evaluation of practice activities.Tools to help define roles Physician governance and ongoing participation in practice management activities is as unique as each individual group. The administrator's role is as unique as each employment contract.

Fortunately, there are tools available to help both parties understand the scope of the administrator's job, and to help determine levels of physician participation. Whether it's one managing partner or an executive committee of the board of directors, the administrator can ask for clarifi-cation of responsibilities in each of the performance domains outlined in the American College of Medical Practice Executives (ACMPE) Guide to the Body of Knowledge for Medical Practice Management.

The administrator has presumably developed the general competencies of:
• Professionalism; do the physicians in your group fit into the outline? Does one managing partner handle everything or does cach physician owner take responsi-bility for one or more areas and work with the administrator to determine
• Leadership;
• Communication skills;
• Organizational and
analytical skills; and
• Technical and professional knowledge and skills.
Practice policies in that area?
By identifying the physicians who have managerial responsibilities in each area, the administrator identifies the people who are in a position to evaluate the financial impact of those operations,

In this last area, the administrator can use the ACMPE's outline of eight performance domains to identify the physician, committee or other
individuals who will participate in the management of that aspect of the practice. There is no correct amount of participation or oversight for physicians in these areas, but there is an essential requirement that the physicians and administrator understand who is
and to work with the administrator to develop proposals for change. This is the decision-making team who must agree on the implementation of business policies, and must have the authority to carry out necessary changes. This is also the team that can help employees understand the clinical and financial implications of business decisions.
Anticipating resistance to change, or reluctance to adapt to new policies, is a necessary part of business management. Resistance or reluctance from physicians is best addressed early if proposed
changes will change the doctor's usual workpatterns. Physicians and management must present a unified
front and a positive attitude, to insure that every member of the practice feels that their efforts are respected and understood. Everyone should
feel they have a stake in the success of the practice.
ultimately responsible for the tasks identified within each domain. Each must also understand that accepting responsibilityfor an area must also be accompanied by some authority to make changes and accountability for those decisions.As you review the eight performance domains within your own practice,consider the personalities of the physicians and staff who currently influencethese areas of practice
management:
• Financial management;
The initial premise of this article was that the administrators of successful.
• Human resource management;
• Governance and organizational dynamics; medical groups have learned how to use the art and science of medical practicemanagement to instill good business practices into the culture of their medical groups. Successful administrators have access to the information and authority needed to
implement good business practices. They will also be able to effectively communicate with the physicians
who comprise the practice, and the employeeswho perform the day-to-day clinical operations. With clear
understanding of the rights and responsibilities of each party, it is possible to successfully manage the
• Planning and marketing:
• Information management;
• Risk management;
• Business and clinical operations; and
• Professional responsibility.
Every aspect of medical practice operations falls within these domains. Some areas may have increased or diminished importance, depending on the group's unique situation, but none iscompletely absent. How, then, interface between the business of medicine and the practice of medicine.

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