Oates and Company Blog

Competition is useful because it can encourage practitioners to push past their perceived limits and reach higher levels of achievement. Over time, sustained competition will make practitioners better at providing medical services; the desire to succeed will encourage them to work on new skills and gain new qualifications. 

Internal competition, however, can be a double-edged sword. Even though encouraging competition is simple, encouraging the right kind of competition is not. Some forms of competition can strengthen multi-physician practices, but others can cause stress and strife among fellow physicians. Uncorrected, these forms of competition can lead to physician burn-out, which, if not addressed, will lead to serious problems with their performance.

To combat these potential problems, managers of multi-physician practices must learn to use the right methods of encouragement. For example, the threat or use of punishment can be used to encourage competition, but it’s an ineffective way to do so – punishment is counter-productive because of its negative impact on morale. Managers should instead use rewards because it positively impacts performance and, mostly importantly, a physician’s belief that he/she can try new things without fear of recrimination.

Rewards need not be expensive. In fact, one of the most popular rewards is verbal praise, particularly in front of others. Managers of multi-physician practices must make sure, of course, that their verbal praise toward one physician doesn’t also serve to belittle another physician – the goal is to encourage cooperative competition between their physicians rather than causing them to dislike and distrust one another. Certain rewards, like financial compensation, are almost guaranteed to inspire hostile interactions between participants. On the other hand, if a manager chooses to offer a financial bonus to all participants who exceed a certain level of achievement, a competitive spirit can be encouraged without sacrificing the cooperation that is essential to multi-physician practices.

The reward structure should be made clear to the all participants at the multi-physician practice. Physicians should understand both the nature of the reward and how to receive the reward. Furthermore, physicians should receive regular updates on their progress toward the goals. However, too much emphasis on the rewards can cause physicians to become stressed out, meaning that it is best for managers to keep the competition as light-hearted as possible.

Revenue sharing in a multi-physician practice is often done on a production based system. Production based pay gives the harder working physicians a larger slice of the earnings. Revenue allocation is also sometimes done based on a percentage of the revenue regardless of an individual's production. Both of these methods have pros and cons.

If the group is a single specialty group, both systems can often be used – a flat, smaller percentage divided equally and another portion based on production. This can depend on the type of specialty; if two doctors share the same specialty, equal payment can encourage them to back each other up; if one doctor is out sick or on vacation, the other doctor willingly steps up to help cover the workload.

In practices with multiples specialties, production based revenue allocation is an often used method. A large number of groups use receipts to measure productivity, where the direct costs are subtracted from the revenue and overhead costs are assigned. This system may seem fair but in areas of the country where most patients have low billable amounts, some physicians will be at  a disadvantage. This will require the group to find a way to balance the mix.

How expenses of the practice itself are divided among the group can have a huge effect on income distributions. If expenses are to be divided evenly, it would be best if all the doctors’ revenue is somewhat equal. The other option is to charge all expenses that can be tracked to the doctor who uses them. This, however, could cause physicians to start taking shortcuts to save money and could affect the quality of care given to patients.

Regardless of how the revenue allocation is decided, an accurate and understandable system must be in place. All members of the group need to feel that they are getting a fair share and no one should feel as if they are carrying the bulk of the load.

A major obstacle for medical practices is record-keeping. Records of patient visits, payment methods, invoices, types of treatment given, and medications prescribed are all examples of what medical practices keep track of. What many people don’t consider, however, is that medical practices – just like every other business – also have to keep track of employee hours, inventory, overhead costs, and profitability.

Businesses worry about many things: cost efficiency, profitability, inventory, employee management, customer service, etc. Medical practices must worry about all of those and more: confidentiality, record-keeping, insurance, safety, and efficacy.