Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large,
Several factors are important when deciding to make the transition to an employment model with a local hospital system.
Arthur Tarantino, MD, began his urology practice in 1988, and a few years later merged with several small entities to form an 11-person, single-specialty urology group. This group subsequently became the nidus for a Connecticut-based multispecialty surgical group (including urology, general surgery, colorectal surgery, cardiovascular surgery, and podiatry) that grew to 45 providers and 150 employees.
The group achieved sufficient scale to develop centers of excellence, a solid reputation in the community, high practice volumes, and a robust practice and information technology infrastructure. Despite this growth, Dr. Tarantino's practice ultimately opted to enter an employment relationship with Hartford HealthCare, a health system in Hartford, CT.
In addition, Dr. Tarantino notes some of the difficulties that sometimes accompany rapid growth: lagging internal processes, struggles to recruit and retain quality managers, evolving compensation models among physicians, and capital costs associated with maintaining the IT infrastructure. Also, Connecticut is a highly regulated state with minimal opportunity for urologists to generate revenue from ancillary services such as imaging, pathology, and intensity-modulated radiation therapy. These pressures began to threaten the ability of the group to retain and recruit physicians. Taken together, the group started to explore the possibility of an employment model with Hartford HealthCare.