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A financially successful and stable practice is an important component of professional physician satisfaction for the community-based emergency physician group. Financial success, in turn, helps to create an environment, in which a stable group of highly qualified emergency physicians can provide excellent clinical care within the framework of a positive and stable relationship with the emergency department (ED) staff, medical staff, and hospital administration. As with any other business venture, a financially successful group may reinvest profits in the group to

  • Maintain or increase its revenue stream
  • Recruit and retain quality physicians
  • Improve the practice

This chapter will introduce concepts that will provide the groundwork for a community-based emergency physician group to achieve stability and financial success.

Effective group leadership is a crucial factor in a successful emergency physician group. Intelligent and prudent emergency group administrators with foresight are adept at making wise decisions. They additionally should possess the personality traits and ability to affirmatively guide, motivate, and mentor the group's physicians. Selection of group's administrators should also be based on their abilities to communicate and work with the medical staff, nursing, and hospital administration. Effective intra-hospital relationships help to maintain the contractual relationship that guarantees maintenance of the group revenue stream.

The successful private group should ensure its leadership has the requisite protected administrative time and corresponding financial and administrative support. In many EDs, the amount of time devoted to group leadership is inappropriately low and poorly supported, leading to poor group performance and instability that can place contractual relationships with the group's hospital at risk. A reasonable estimate for administrative time allocated to a specific group is 1 hour per week per thousand ED visits (ie, 50 hours of paid administrative time and protected time a week allocated for a 50,000-volume ED).

The group's physicians should carefully select the most capable leaders. Ideally, the clients of the emergency physician group, including the hospital administration and medical staff, receive this selection with approval. Nonapproval by the hospital or medical staff should raise concern and pause within the group, as it may hint at discomfort with the individual and eventually lead to friction and discord. Formal leadership programs may provide the selected leaders with additional skills and the foundation that propels him or her and the group forward. These programs, such as the American College of Emergency Physicians “Emergency Department Directors Academy” and The Governance Institute's “Leadership Conferences,” are well worth the time and nominal expense. Additionally, effective groups periodically revisit their leadership decisions. The group may benefit from changing leadership, when

  • Existing leadership becomes less effective, influential, or respected.
  • The environment or hospital leadership changes and the current leader(s) is unable to adapt.
  • New leaders emerge from within the group.

Selecting a suitable group structure is pivotal to the group's formation, physician professional satisfaction and retention, and group stability. A properly planned structure maximizes stability, ...

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