McCarthy G J
Columbia Hospital, Milwaukee.
Health Prog. 1991 Dec;72(10):50-3.
Group practices have become increasingly popular among physicians in recent years. And as competition increases and operating margins become perilously thin, hospitals with significant group practice participation among medical staff appear to be in an enviable position. Before deciding to promote group practices, however, hospital managers should be become familiar with their advantages and disadvantages and determine whether a market exists for group practice development at their facility. The advantages for hospitals include more effective recruiting and a more stable patient base. Among the disadvantages are the fact that groups give physicians a stronger power base from which to request concessions from the hospital and that a preponderance of group-affiliated physicians on staff may discourage referrals from nongroup physicians. A number of considerations are involved in preparing for and coordinating group practice development. In the planning stages open communication with physicians is critical. Physician leaders and a cross section of active staff should participate. Planners should discourage formation of "groups without walls," in which hospitals manage group practices of physicians who remain at different sites. A hospital may, however, choose group-like arrangements (e.g., limited partnerships) without necessarily promoting group practice. Hospitals may also help a group purchase a facility of its own or even create the facility and allow the group to build equity in it.
近年来，集团化医疗实践在医生群体中越来越受欢迎。随着竞争加剧，运营利润率变得极其微薄，医务人员中集团化医疗实践参与度较高的医院似乎处于令人羡慕的地位。然而，在决定推广集团化医疗实践之前，医院管理者应该熟悉其优缺点，并确定其机构是否存在集团化医疗实践发展的市场。医院的优势包括更有效的招聘和更稳定的患者群体。缺点包括集团会赋予医生更强的权力基础，使其能够向医院要求让步，以及大量与集团相关的医生在职可能会阻碍非集团医生的转诊。筹备和协调集团化医疗实践发展涉及多个考虑因素。在规划阶段，与医生的开放沟通至关重要。医生领导者和一部分活跃的员工应该参与进来。规划者应该阻止形成“无墙集团”，即医院管理那些仍在不同地点的医生的集团化医疗实践。然而，医院可以选择类似集团的安排（如有限合伙制），而不一定推广集团化医疗实践。医院还可以帮助一个集团购买自己的设施，甚至创建该设施，并允许集团在其中建立权益。
