You don't have to go down with the ship

MGMA Connexion, Sep 2004 by Jones, Tracie L

Commentary, interpretations, thoughts, opinions Discourse

Like any medical professional, I take my work seriously. I believe it is a reflection of who I am. I strive to stay ahead of the pack regarding change and improvements for a medical practice.

After 25 years in medicine, I have learned that health care administrators' jobs and our leadership positions are just as full of risk and consequence as those of physicians.

A few years ago I took a position with two surgeons struggling with the volume of work. We brought two more surgeons into the group, and things grew more manageable. The practice underwent a major internal and external renovation. Within three years, we became the largest surgical specialty practice in our metropolitan area; I was as proud as anyone could be. We exceeded the better-performer benchmarks data from the Medical Group Management Association in every aspect.

Then the latest medical malpractice insurance crisis came to our state.

Soaring malpractice premiums kill the practice

The previous year we had paid $97,000 for our four surgeons to carry professional liability insurance. Our renewal came in at $260,000. We shopped around for new quotes, but this was as good as we could get. We accepted the challenge of the premium.

I looked at every item in our financial statement, seeking opportunities to lower costs. But after nine months of belt-tightening, we just could not make the next premium payment. Faced with closing the practice or dropping our malpractice insurance, we chose to go "bare." We had plenty of legal asset protection in place and understood the repercussions of having no malpractice coverage. We thought we could stand firm and continue to work as before.

However, the two senior partners were at odds on the issue. The two younger physicians announced that they were thinking about leaving the practice and the state. In the end, they departed. The second senior partner resigned, believing he could do better on his own. This came as a shock to the office and the physician who had started the group 20 years ago.

Our newly renovated office went up for sale. The staff had three months to prepare for the move. It became a game of "Office Survivor": Which employees would go with which doctor? Which doctor wanted which employees? Some employees ended up on more than one list, causing hurt feelings and hot tempers. I received an ultimatum from the senior partner to choose between him and the other older physician. I was so insulted to be put in this position that I decided to leave after getting the group through the office closure.

Closing the practice - a nightmare

The next month at the practice was a living hell. The back-biting and head games wore down my nerves. I got sick every morning before I went to work. Only sleep shut off the pain of seeing the practice disintegrate before my eyes. I made some mistakes that will haunt me for a long time.

Near to having a nervous breakdown, I sought counseling and rehabilitation. I was grateful for the support of my husband, a mentor and a new accountant who resolved the separation agreement with the physicians. Over two months of not working, I began to heal. But I felt guilty that I wasn't at the office to shut it down.

My personal physician told me that if I had stayed at the practice until the bitter end, there would have been nothing left of me with which to make a new start.

Aftermath

It's been a year now since the ordeal ended. I sometimes wonder why I still work in practice management. But then I see what a difference I can make for others because of my experience - and I know this is what I am meant to do.

The lesson I learned: You don't have to go down with the ship, but knowing when to jump is difficult.

I love what I do for a living. I tell people that there are still days when I experience "firsts," and that's what keeps me coming back to learn from my profession as a practice manager.

I see what a difference I can make for others because of my experience - and I know this is what I am meant to do.

about the author

Tracie L. Jones, MGMA member and practice administrator, Today's Healthcare, Winter Springs, FIa., traciejtrace@aol.com