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Department: Business Management

Simple Changes Boost Productivity
Simple changes in physician practices may pay off big in practice productivity, quality, and satisfaction. Many physician leaders regard large integrated multispecialty clinics as the most rational solution for solving small-practice woes; in other words, work together in large systems or die. Fitzhugh Mullan, MD, author of Big Doctoring in America: Profiles of Primary Care and a family doctor on the board of editors of Health Affairs, describes these physician leaders as “system doctors,” because they are medical directors of large health systems. In his book The Innovator’s Dilemma, Clayton M. Christensen, a professor at the Harvard Business School, says that “disruptive solutions” can undermine even the best managed organizations, even large medical groups. A disruptive solution is a new technological invention, product, or service that eventually overturns the existing dominant technology or product in the market. Simple, convenient, and powerful innovations aimed at the low end of the market disrupt large organizations. In health care, the market’s low end is primary care physician practices, and the high end is large multispecialty organizations. Like all large organizations, they may be mismanaged, develop bloated overheads, become overly bureaucratic, and may not appeal to physicians who seek more autonomy. In short, large organizations are complicated bureaucracies, and many, if not most, physicians do not feel comfortable in complicated working environments.

Recruiting the Best Nephrologists
When a nephrology practice is growing, the partners must work harder and at the same time recruit new practitioners to take up the slack. But before adding staff, nephrologists should consider the options carefully, because new staff will shape the practice’s future direction, says Martin H. Osinski, president of Nephrology USA, a recruiting and consulting firm in Miami. Practices have several options, says Osinski, who has 20 years of experience in nephrology recruiting. They can hire a young nephrologist out of fellowship training, a seasoned nephrologist, or a midlevel practitioner, such as a physician assistant or nurse practitioner. This third option is becoming increasingly popular. A growing number of nephrology practices are turning to midlevel practitioners, rather than hiring a new physician. With supervision, midlevel practitioners can assume some of the work that physicians would do otherwise, such as primary care, following up on office visits, and working with dialysis patients. They also staff chronic kidney disease clinics and vascular access centers.