Combining Assets and Activities
The community of Tampa, Florida, has a diverse population, with healthcare being provided to persons
with low incomes, extremely wealthy individuals, and a strong middle class. Three well-established
physicians—an obstetrician, a gynecologist, and a urology specialist—decided that they should combine
their practices into a unique new organization. They believed that numerous patients would be
attracted to these separate, but interrelated, medical practices.
The three physicians worked together to create a plan. They decided that each physician would have
privileges, or authority to practice, in more than one organization. Beyond their individual practices, the
doctors would perform surgeries and provide additional medical care in several local area hospitals. In
the new practice, their days would be divided into times in which they tend to routine examinations, to
patients with medical problems that are not emergencies, to making rounds at the hospital to check up
on patients, and to conducting other medical care.
The new organization would be housed in a major medical building. A support staff, consisting of those
who could help with patient scheduling, insurance claims, billing, and other office duties, would be
combined with three full-time nursing assistants. The physicians chose one individual for the role of
office manager to oversee all of the support activities.
The obstetrician also employed a clinical nurse practitioner with responsibilities that would be more
medically complex than those usually associated with nursing. The obstetrician found the practitioner's
help particularly useful to her practice.
The new organization intended to hire one more person to serve as a liaison to the hospitals that the
physicians attended, with the goal of ensuring smooth coordination between the newly formed
organization and the hospitals. The new person would be in charge of resolving any disputes or
This new organization, which had yet to determine its name, would be a partnership. The three
physicians would share authority and the direction of the medical practice. Decisions about difficult
issues, such as adding a new form of care or bringing in an additional partner, would be made by
majority rule, or agreement by two of the three doctors. The three physicians agreed that they should
eventually grow to the point at which each had a second specialist in his or her area, which would
expand the organization to six doctors. They believed the benefit of such growth would be having a
person to answer calls when another specialist was unavailable. It would also potentially increase the
number of specific medical procedures the unit would be able to offer to the community.
With these principles in mind, the physicians agreed it was time to design the organization.
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