Physicians graduate from medical school armed with clinical knowledge, but usually are not educated in non-clinical aspects of practicing medicine. “Although doctors receive plenty of training so they can save lives, most receive precious little education on how to run a small business, which is what a practice really is.” 1 

For example, group practices require both business acumen and the ability to address potential conflicts in personality, style, and finances. “Working in a group practice is . . . demanding, as building and maintaining a strong supportive partnership requires time and effort . . . and can produce tensions,” which can result in group breakup 2 or can contribute to unhappiness and burnout—conditions increasingly common in today’s medical environment, especially among primary care physicians. 3

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A recent study 2 explores “the reasons for breakups in group practices” and describes “the practitioners’ feelings about this experience” by conducting in-depth interviews with 21 general practitioners and one secretary from past group practices. 

A second study consisting of site visits to 23 “high-functioning” primary care group practices serves as a counterpoint to the first study by looking at factors that “facilitate joy in practice and mitigate physician burnout.” 3

Hope and Disillusionment

Subjects interviewed by Marechal et al 2 embarked upon group practice anticipating “improved quality of life for the practitioner, increased continuity of care for the patient, better sharing of experience between healthcare providers . . . increased support from colleagues,” and greater financial security. 2 In the words of one subject, “I had big illusions and really high expectations.”

What factors allow physicians to enjoy the original goals of group practice and avoid factors that lead to unhappiness, burnout, and group breakup?

Assuring Evenhanded Distribution

Uneven distribution, based on a “hierarchy” favoring seniority, was a frequent cause of breakup in group practices. 2 This type of preferential treatment applied not only to uneven patient load, but also to the execution of duties and chores.

Subjects recommended an “equal distribution of common duties,” perhaps via a rotation method, and emphasized that no partner “should have excessive power or authority over the others.” 2 Additionally, there should be a “fair, concerted sharing of common duties, workload, space, and secretarial time.” 2 These should be defined at the outset, in the form of bylaws that outline the division of labor and responsibilities. 4

Bridging Incompatible Styles

Incompatible styles in finances, organization, personality, or leadership was another major cause of practice breakups. 2