Organizational synergy in medical groups.

True synergy, as an organizational design, is uncommon in medical groups. This article addresses the experiences of a medical group that practiced an extreme form of synergy--the total equality of its physicians--since its inception almost 30 years ago. Synergy is the close coordination of the efforts and resources of individuals working together so that the performance of the whole is greater than the sum of the parts. Why use synergy in organizational design? By flattening the hierarchical levels, synergy addresses key issues of power (control, resource allocation, planning) and money (salary, bonuses, benefits), treating all physicians as equal partners. It also ensures access to the highest-quality candidates because the lure of equality, ownership, and permanence is so powerful. Synergy in medical groups works best where there is: A clearly stated mission and vision statement, as well as specific goals and objectives; careful selection of associates; a small group of between seven and nine members; a short-term duration of ten years or less; and a certain simplicity, whereby the group avoids risk-prone ventures or projects that distract it from its original mission and vision.

Economic credentialing: the propriety of managing physician costs through privileging.

Hospital executives face the unique task of managing the costs of an institution in which they have no direct managerial authority over the primary cost drivers, namely, the physicians who practice in the hospital. Perhaps the most controversial method of controlling physician costs consists of the application of economic factors to the credentialing process. Using the credentialing process as a technique to exert fiscal control over physicians affords hospital executives and their governing boards a tremendous cost-management opportunity. The legal propriety of economic credentialing remains unsettled. Many commentators, relying on limited case law, conclude that hospitals can engage in economic credentialing. Nevertheless, hospitals should exercise care when employing an economic rationale to restrict privileges lest they stir up legal challenges. Moreover, if hospitals use economic credentialing to limit medicaid patients' access to hospitals by excluding these patients' physicians from the hospital, the federal government may have the last word on the propriety of the practice.