Partners should be selected carefully, based on similar personalities and professional styles, visions and values, after a probationary period. A conflict management structure should be created—for example, bringing in a third party (eg, a management consultant or mediator)—if partners are unable to resolve differences themselves. 2,4

Improving Communication

Lack of communication or misunderstandings contributed to many breakups.Whenever there was a big crisis within the group, it was when we no longer took the time to communicate.” 2 

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Successful practices described the use of “improving team communication through co-location, huddles, and regular team meetings” and reducing “asynchronous e-messaging.” 3

Flexibility and Openness to Change

Many subjects emphasized “basic human qualities” that promote a successful group practice, noting the importance of “honesty, respect, tolerance, and open-mindedness.” They encouraged physicians to “make concessions and accept differences” and “allow for change and evolution within the group.” 2

Reducing Tensions by Reducing Workload

Relieving physicians of onerous duties improves physician satisfaction and enhances group cohesion. Strategies include “proactive planned care” (eg, previsit planning and laboratory tests) 3 and shifting certain responsibilities to non-physician team members (eg, nurses, health coaches, or medical assistants) who can filter incoming communications, passing on to the physician only what requires physician expertise. 3  

Non-physician team members can also be present during patient visits and assume post-visit tasks such as medication reconciliation, order entry, summary, and visit note documentation. 3 One physician describes being “far more satisfied. I leave work an hour earlier every day and have a very fulfilling relationship with my team . . . We’re having fun.” 3

Creating a Clear Contract

A contract is an essential way to protect the interests of all parties in a group practice. It should include issues such as work distribution, on-call requirements, and partnership buy-ins. 4 It should also “state the internal rules for practice management, including clauses in the event of breakup.” 2


Group practice breakups are often characterized by longstanding feelings of “loneliness and suffering.” 2 Shifting from a “physician-centric model of work distribution and responsibility to a shared-care model . . . and frequent forums for communication can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.” 3


1. Jackson R.  Medical school didn’t prepare you for this. (2008) Available at: Accessed: June 9, 2013.

2. Marechal F, Schmidt D, Lasserre E, Letrilliart L. When the group practice breaks up: a qualitative study. BMC Fam Pract. 2013;14:53.

3. Sinsky CA, Willard-Grace R, Schutzbank AM, et al. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med. 2013;11(3):272-278.

4. Berry E. Pain management for practice breakups.  AMED News, 2011. Available at: Accessed: June 10, 2013.