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  • Group Practice in Ophthalmology, Dr. Vidushi Sharma, DR Suresh K Pandey, Suvi Eye Institute, Kota, Rajasthan, India

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    Dr Suresh K Pandey
    423 views54 pages
    Why Ophthalmic Group Practice? In recent years, Group Practice has become a concept, that is often talked about, and everyone seems to wax eloquent on how good and useful Group Practice can be for all involved. And yet, there are very few examples of a really successful group practice, where the stakeholders are all happy and the association can last for a long time. So, what is it about Group Practice that makes it an idea, “easier discussed than implemented”? Why is it that the list of perceived advantages of Group Practice is so long, and yet there are few models in practice, from which beginners can take inspiration and follow their example? Or is it that ophthalmologists are simply not suited for the concept? And after all, why make the change from Solo to Group practice, when solo practices have survived and done well for years? In this presentation, Dr Vidushi Sharma and Dr Suresh K Pandey share their experience of Ophthalmic practice at Suvi Eye Instititute, Kota, Rajasthan, India     Dr Suresh K Pandey- A medical graduate of Rani Durgawati University, Medical College, Jabalpur, M.P., India; Dr. Pandey completed his residency in Ophthalmology from prestigious Postgraduate Institute of Medical Education and Research, Chandigarh, India. He worked in USA & Australia from1998 to 2005 and currently appointed as Adjunct Assistant Clinical Professor at the John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA. Dr. Pandey returned to India in 2006 to establish SuVi Eye Institute and Research Cente at Kota, Rajasthan, India. Dr. Pandey has extensive clinico-surgical and research experience in the field of ophthalmology, adult and pediatric cataract-intraocular lens surgery. He has presented more than 150 scientific papers in various international ophthalmological meetings and authored more than 100 scientific papers/communications, 50 textbook chapters, and 10 ophthalmic textbooks. His classic book on Pediatric Cataract Surgery, published by Lippincott Williams and Wilkins, remains the best-sellar on this topic. Dr. Pandey received several prestigious awards for his research & surgical innovations, which include Best-of-Show Video Award, Best Poster Award, Best-Paper-of-the-Session Award for the surgical videos, scientific posters and papers in the national and international ophthalmology congresses including American Society of Cataract and Refractive Surgery, European Society of Cataract and Refractive Surgeons, American Academy of Ophthalmology, etc. Most recently, Dr. Pandey has been selected for Achievement Award by the American Academy of Ophthalmology. He also serves as reviewer for several peer-reviewed Ophthalmology journals. Dr. Pandey can be reached at the Suvi Eye Institute & Research Centre, A 475 Indra Vihar, Kota, Rajasthan, India; Phone +91 (744) 2433575; 093514-12449 (mobile); E-mail: suvieye@gmail.com, phacolasiktraining.com

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    Why Ophthalmic Group Practice? In recent years, Group Practice has become a concept, that is often talked about, and everyone seems to wax eloquent on how good and useful Group Practice can be for all involved. And yet, there are very few examples of a really successful group practice, where the stakeholders are all happy and the association can last for a long time. So, what is it about Group Practice that makes it an idea, “easier discussed than implemented”? Why is it that the list of perceived advantages of Group Practice is so long, and yet there are few models in practice, from which beginners can take inspiration and follow their example? Or is it that ophthalmologists are simply not suited for the concept? And after all, why make the change from Solo to Group practice, when solo practices have survived and done well for years? In this presentation, Dr Vidushi Sharma and Dr Suresh K Pandey share their experience of Ophthalmic practice at Suvi Eye Instititute, Kota, Rajasthan, India     Dr Suresh K Pandey- A medical graduate of Rani Durgawati University, Medical College, Jabalpur, M.P., India; Dr. Pandey completed his residency in Ophthalmology from prestigious Postgraduate Institute of Medical Education and Research, Chandigarh, India. He worked in USA & Australia from1998 to 2005 and currently appointed as Adjunct Assistant Clinical Professor at the John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA. Dr. Pandey returned to India in 2006 to establish SuVi Eye Institute and Research Cente at Kota, Rajasthan, India. Dr. Pandey has extensive clinico-surgical and research experience in the field of ophthalmology, adult and pediatric cataract-intraocular lens surgery. He has presented more than 150 scientific papers in various international ophthalmological meetings and authored more than 100 scientific papers/communications, 50 textbook chapters, and 10 ophthalmic textbooks. His classic book on Pediatric Cataract Surgery, published by Lippincott Williams and Wilkins, remains the best-sellar on this topic. Dr. Pandey received several prestigious awards for his research & surgical innovations, which include Best-of-Show Video Award, Best Poster Award, Best-Paper-of-the-Session Award for the surgical videos, scientific posters and papers in the national and international ophthalmology congresses including American Society of Cataract and Refractive Surgery, European Society of Cataract and Refractive Surgeons, American Academy of Ophthalmology, etc. Most recently, Dr. Pandey has been selected for Achievement Award by the American Academy of Ophthalmology. He also serves as reviewer for several peer-reviewed Ophthalmology journals. Dr. Pandey can be reached at the Suvi Eye Institute & Research Centre, A 475 Indra Vihar, Kota, Rajasthan, India; Phone +91 (744) 2433575; 093514-12449 (mobile); E-mail: suvieye@gmail.com, phacolasiktraining.com

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    Group Practice in Ophthalmology, Dr. Vidushi Sharma, DR Suresh K Pandey, Suvi Eye Institute, Kota, Rajasthan, India

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    Dr Suresh K Pandey
    Why Ophthalmic Group Practice? In recent years, Group Practice has become a concept, that is often talked about, and everyone seems to wax eloquent on how good and useful Group Practice can be for all involved. And yet, there are very few examples of a really successful group practice, where the stakeholders are all happy and the association can last for a long time. So, what is it about Group Practice that makes it an idea, “easier discussed than implemented”? Why is it that the list of perceived advantages of Group Practice is so long, and yet there are few models in practice, from which beginners can take inspiration and follow their example? Or is it that ophthalmologists are simply not suited for the concept? And after all, why make the change from Solo to Group practice, when solo practices have survived and done well for years? In this presentation, Dr Vidushi Sharma and Dr Suresh K Pandey share their experience of Ophthalmic practice at Suvi Eye Instititute, Kota, Rajasthan, India     Dr Suresh K Pandey- A medical graduate of Rani Durgawati University, Medical College, Jabalpur, M.P., India; Dr. Pandey completed his residency in Ophthalmology from prestigious Postgraduate Institute of Medical Education and Research, Chandigarh, India. He worked in USA & Australia from1998 to 2005 and currently appointed as Adjunct Assistant Clinical Professor at the John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA. Dr. Pandey returned to India in 2006 to establish SuVi Eye Institute and Research Cente at Kota, Rajasthan, India. Dr. Pandey has extensive clinico-surgical and research experience in the field of ophthalmology, adult and pediatric cataract-intraocular lens surgery. He has presented more than 150 scientific papers in various international ophthalmological meetings and authored more than 100 scientific papers/communications, 50 textbook chapters, and 10 ophthalmic textbooks. His classic book on Pediatric Cataract Surgery, published by Lippincott Williams and Wilkins, remains the best-sellar on this topic. Dr. Pandey received several prestigious awards for his research & surgical innovations, which include Best-of-Show Video Award, Best Poster Award, Best-Paper-of-the-Session Award for the surgical videos, scientific posters and papers in the national and international ophthalmology congresses including American Society of Cataract and Refractive Surgery, European Society of Cataract and Refractive Surgeons, American Academy of Ophthalmology, etc. Most recently, Dr. Pandey has been selected for Achievement Award by the American Academy of Ophthalmology. He also serves as reviewer for several peer-reviewed Ophthalmology journals. Dr. Pandey can be reached at the Suvi Eye Institute & Research Centre, A 475 Indra Vihar, Kota, Rajasthan, India; Phone +91 (744) 2433575; 093514-12449 (mobile); E-mail: suvieye@gmail.com, phacolasiktraining.com

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    of 54

    Group Practice in Ophthalmology

    Dr. Vidushi Sharma


    MBBS (AIIMS, New Delhi),
    MD (Ophthalmology,
    AIIMS, New Delhi),
    FRCS (UK)

    Dr. Suresh K Pandey,


    MS (Ophthalmology, PGIMER,
    CHANDIGARH),
    Anterior Segment Fellowship (USA)

    Director, SuVi Eye Hospital & Research Centre


    C-13, TALWANDI, KOTA, RAJASTHAN, INDIA
    Email- suvieye@gmail.com
    Phone +91 9351412449, 0744 2433575
    www.suvieye.com
    What is the Need?

     Changing, more
    demanding society
     Expected to become
    efficient and contain
    costs (US example)
     So, new models to
    re-organize rather
    than being forced to
    do so

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Too Many Players

    Lone doctors
    Corporates, Insurance Companies, TPAs, Advertising
    Gurus, Marketing Executives, Image Makeovers,
    Pharma Giants
    Dr. Vidushi, MD, FRCS
    www.suvieye.com
    Why Ophthalmic Group Practice?

     To Share costs of
    equipment
     Better schedule giving
    more personal time
     Hire, share, maximally
    utilize, better staff

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    What’s Wrong with SOLO?

     Absolutely nothing!
     You make own decisions, only
    arguments are with spouse
     You decide own time of working
     You decide own direction of future
    growth
     Whatever money you make is all yours

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Let’s Rethink!

     Cutting medical
    equipment costs
     Solo eye surgeon – about 25 – 30
    lakhs
     Group practice – about 2-3 crores
    plus (including all sub-specialties)
     Other options to cut costs, e.g. mobile
    Yag laser, shared OT services etc.,
    loaned/leased equipment

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    More Personal Time

    Work generally
    increases as the
    size of practices
    increases

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Is Group Practice an
    Idealistic Myth?
     No, but the real benefits are
     Better patient care, cross-opinions
     Improved quality of service
     All sub-specialties & referrals under one
    roof (nucleus drop!)
     Lower cost of care (e.g. same fee for all
    sub-specialties)
     Some leverage for personal work, illness
    etc.
     Investment same but better equipped with
    the latest, not necessarily most profitable

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice Enhances Practice

    Bigger with more variety looks better, attracting


    more patients and less doubts (legal hassles)
    Dr. Vidushi, MD, FRCS
    www.suvieye.com
    So….
     Not a moral or social obligation
     Not for achieving easy money with
    minimal investment and having more
    personal time
     But for doing better quality work
     Not a short cut to success, but a
    means to achieve a broader vision

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Options

     Many variations on the basic theme of


    group practice

     Common theme of sharing expenses,


    administrative duties and returns

     Even LVPEI etc. are variations of GP

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Best Option

     Must have clear goals


    for solo or group
     Agree on goals
     Advantages and
    disadvantages for both
     Study all available
    options before deciding

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Golden Rules for
    Group Practice

     Different strengths and


    weaknesses
     Don’t compare your deal with your
    partner, but what if solo
     No such thing as 50-50 partnership;
    perfect equality is a myth
     Don’t use administrators or lay staff
    between doctors

    Dr. Vidushi, MD, FRCS (Partly adapted from JB Pinto)


    www.suvieye.com
    Maintaining Group Practice
     “Keep your eyes
    wide open before
    marriage, and half
    shut afterwards.”

     TEAM work
    “Together Everyone
    Achieves More,”

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Why Stick Together?

     Your common vision of what


    you can create together & fear
    that practicing alone would be
    worse.
     Focus less on faults, more on what’s
    good with your group
     Wonder why you compete within the
    group rather than outside

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Financial Matters

    Ouch!
     Production-based
    compensation
     Salary
     Group-based
    compensation unrelated
    to individual physician
    productivity
     Capitation-based
    compensation

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    More Personal Time
     Mostly emergency calls
    increase in big practices
     Really large group to reduce
    frequency of calls
     Easier to handle own patients’ calls
    than covering for colleagues’ patients
     Lot of time spent in meetings and
    discussions between doctors, often
    less than pleasant

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    West vs India

     Many differences in way of working


     System of appointments vs walk-in
     High administrative and legal costs in
    West due to too much paperwork,
    regulation, insurance etc.
     Concept of time off in society in general
     We still operate like “Seths” (rich
    person), building medical businesses
    for sons & daughters

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Staff Utilization
     Hire, share, maximally utilize, better
    staff
     A well run group will always have more
    waste than an efficiently run solo
    practice
     Yet this is a tangible benefit
     Other options like outsourcing of
    services, part time employees etc.

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Lessons from Others

     Gaining more leverage with health


    plans is THE most important reason for
    forming medical groups in USA

     Lack of cooperation, lack of investment


    and lack of support for leadership are
    barriers to success of group practices
    (Benefits of and Barriers to large medical group practice in
    the US. Archives of Internal medicine 2003;163:1958-64)

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Different options at different stages

     Keep all your


    option opened

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Common Roadblocks!
     Variations in training style
    and patient management can
    be difficult to overcome
     Physicians’ reluctance to reward leaders
    who spent time in building or running a
    group
     Difficult to find administrators with
    experience in this field
     Let everyone sing their own tune and yet
    no cacophony

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Common Complaints

     “I don’t really ever feel appreciated


    here; I feel like second fiddle”
     “I don’t have enough voice in
    operations; I’m never consulted”
     The senior doctor gets all the cases
     Issues build up here without ever
    being discussed

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Plan Early

     Start thinking about your practice in


    residency or immediately thereafter
     Depends on practice location and
    personal desire
     If doesn't work in spite of sincere
    efforts- quit early and pleasantly

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Solo Practice

     Willingness to work wherever,


    whenever, however
     Doing everything yourself
     Long weekend and evening hours
     No coverage for emergency/ illness

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice
     More staff to do administrative work
     30 years of hard work to become an
    overnight success
     More likely to take on each other rather
    than the competition
     Superior management and accounts
    talent
     How to build individuals in a group
     Share non-clinical duties

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Pearls for Successful Group Practice

     If cutting on medical costs is the only


    objective, this would not succeed
     added expense and bureaucracy
     Revenue the only measure of success
     Health care is all about patient
    interaction

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Pearls for Successful Group Practice

     the willingness to make a change is


    based on the balance between the
    pain of the current situation and the
    pain of making the change
     Taking your own call is less onerous
    than sharing call with others
     the need to agree on a common
    vision and goals for the practice and
    make decisions as a group.

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice- Share the expenses

     Land, rentals, building


     Staff
     Medical equipment
     Office supplies, computers, furniture
    etc.

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Rewards of solo

     Idea of running your own business

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     Raising funds or reducing costs can


    not be the only motivation

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Managed care organization

     Independent practice associations


     Group practice without walls
     Consolidated medical group or
    medical group practice
     physician./ hospital organizations
     Physician ownership models

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Remuneration

     American remunerations in many


    fields are artificial supported
    indirectly by federal money and
    therefore the recession

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Avoid becoming “Perfectionist”

     “I’m really frustrated that people


    around here don’t do what they’re
    supposed to do.”
     Translation – “Since I’m the brightest,
    best educated, medically skillful, and
    highest paid person here, everyone
    should respect me and do things my
    way. Which is of course the best.”

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Avoid becoming “Perfectionist”

     “It’s almost impossible to find


    competent, quality employees.”
     Translation – “I’m such a perfectionist
    that no one (including me) can meet the
    unrealistically high standards that I set
    for myself.”

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     Physicians must have equity for long-


    term success
     Quality must come with cost-
    effectiveness, maximum efficiency
    will be demanded by society in near
    future

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Myths

     There is easy money to be made in


    consolidation.
     Equity is not a factor in physician
    productivity
     Separating administration from clinical
    activities is more efficient
     The basic goal of a medical practice is
    to gain covered lives and make money.

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     Gaining negotiating leverage with


    health insurance plans was the most
    frequently cited benefit; it was cited 8
    times more often than improving
    quality.
     Lack of physician cooperation,
    investment, and leadership were the
    most frequently cited barriers.

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Vs Solo Practice

     Bickering about call schedules


     No safety in numbers, everything for
    profit, get sucked into others’
    problems as well
     a well run group will always have
    more waste than an efficiently run
    solo practice.

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     Much more group practices in US but


    highest costs
     doctors argue over pay, workloads,
    schedules, staffing and benefits.
    Squabbling and loss of efficiency
    quickly overcome the economies-of-
    scale on which the partnerships were
    based

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     It is better to try and fail than not


    having tried at all
     Referrals within the group
     More negotiating power
     Decisions by vote

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Practice without walls

     Unless we can evolve models and


    compromise with bosses, financial
    people will be our bosses with little
    regard to any doctors
     If we have to maintain our influence
    tomorrow, we must take tough
    decisions today

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     Essentially reorganize in the new


    society so that we can do what we
    best do – manage patients
     More receptive approach to inevitable
    changes
     Engineers work in groups because
    larger and systematic

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice

     not everyone is going to get a


    perfectly fair, perfectly even deal
     Living with small inequalities is
    obligatory
     Call external help

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Seniors Remember

    Times have changed, life is much faster


    In every age people have romanticized
    the past, yet embraced the future

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Juniors Remember

     It has taken several


    years of hard work
    to become an
    “overnight success”
     Respect the group
    for what it achieved
    before you
     Learn early, grow
    steadily

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Everyone

     Learn to live with


    differences
     Enjoy variety

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Too many cooks may
    spoil the broth………….

    ………but coordinated
    performance can be
    sheer delight
    Dr. Vidushi, MD, FRCS
    www.suvieye.com
    Let’s Not Be Alone……..

    ………In Spreading
    The Light In Society

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice (SuVi Eye Institute,
    Kota, Rajasthan, India)

    SuVi Eye Institute 2006 SuVi Eye Institute 2010

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice at SUVI EYE
    INSTITUTE- Our journey so far…

     Achievements: no
    fisticuffs or verbal
    duels
     Still singing our own
    tunes about what next
     Hopefully a melodious
    “jugalbandi” in near
    future

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    GROUP PRACTICE AT SUVI EYE INSTITUTE,
    KOTA, RAJASTHAN, INDIA

     Established in 2006
     More than 50,000 OPD Cases and more than 5,000
    Minor and Major Surgical Procedures per annum
     Retina Surgery, Glaucoma, Squint Surgery,
    Oculoplastic Surgery, Corneal Surgery procedure by
    fellowship trained specialists
     Cataract Surgery with Implantation of Accommodating,
    Toric and Multifocal IOL
     Regular participation in eye camps and other patients
    education activities
     Regular presentation of papers in various national and
    international ophthalmic meetings

    Dr. Vidushi, MD, FRCS


    www.suvieye.com
    Group Practice in Ophthalmology

    Dr. Vidushi Sharma


    MBBS (AIIMS, New Delhi),
    MD (Ophthalmology,
    AIIMS, New Delhi),
    FRCS (UK)

    Dr. Suresh K Pandey,


    MS (Ophthalmology), Ant. Segment Fellowship (USA)

    Director, SuVi Eye Hospital & Research Centre


    C-13, T ALWANDI, KOTA, RAJASTHAN, INDIA
    Email- suvieye@gmail.com
    Phone +91 9351412449, 0744 2433575
    www.suvieye.com
    Dr. Vidushi, MD, FRCS
    www.suvieye.com

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