Urology group practice: Keys to survival

Dr. Shore is medical director of Carolina Urologic Research Center, Myrtle Beach, SC.

The solo urologist (physician) is an endangered icon of health care delivery. The complexity of urologic care, with the plethora of clinical and scientific advances, in conjunction with regulatory and economic pressures, has rendered the concept of “hanging a shingle” passé. Historically, from Maimonides to Halsted, from the primary care physician to the surgical or medical specialist, inclusive of the specialty of urology, the soloist was the preferred model. However, with the advent of advances in pharmacology, biotechnology, medical devices and therapies, the requisite knowledge for mastering, let alone keeping pace with, the cascade of so many “breakthroughs” has diminished any reasonable opportunity to remain as an all-encompassing generalist within urology. The subspecialties of oncology, voiding and erectile dysfunction, pediatrics, fertility, and minimally invasive therapies warrant devotion of time and study to a far greater degree than ever before.

Additionally, the regulatory and economic expertise necessary to sustain a thriving practice has become more detailed and more time intensive. Symposia and peer-reviewed presentations and publications debate as well as update the economic infrastructure vital to sustaining an effective and profitable clinical model (either hospital or community based); these business essentials are more important today than ever before, as we approach some fashion of a capitated system that will demand and reward performance outcomes. Clearly, an unsustainable, non-profitable business model precludes anyone from providing their services and supporting their work force infrastructure. Group practices must therefore change.

The Large Urology Group Practice Association has a burgeoning membership of more than 120 member practices, encompassing individual membership of over 2,000 urologists. The economies of scale for large groups are apparent. Large groups are able to subspecialize and thus monitor outcomes with the resources of a more sophisticated and structured clinical and business leadership that can adapt and review metrics for the superior deliverability of clinical services.

With further maturity of large groups and improved administrative and clinical oversight, existing clinical lines of service will expand and improve. Currently, many large groups have ownership access to diagnostic radiologic and laboratory services, radiation oncology services as well as dedicated research centers; many urology large groups have full partnership with pathologists, radiation oncologists, and medical oncologists.

The integrative care model can only flourish if pathways of excellence are maintained and superior clinical outcomes data are demonstrated. The urology group practice can incorporate advancing men’s health, inclusive of pediatric through geriatric age ranges, emphasizing preventive as well as diagnostic care. The group practice of dedicated subspecialists can establish its position as a community center of excellence if it accepts the challenge and the need to modify historic practice concepts. A few recommendations for success:

• Select strong physician and non-physician leaders with vision, and compensate them appropriately.

• Create a culture of ongoing and transparent communication.

• Establish the group as the priority; relegate ego and autonomy to the background.

• Prioritize the group outcomes-both clinical and financial-over individual performance as a metric for group sustainability.

• There’s a world of difference between a successful medical group and a group of successful physicians. Collaboration must outweigh mere collegiality; the group must be bound by a common vision and mission rather than only by a professional background and socialization. Most importantly, accountability to the group with integration and interdependence must trump autonomy and individual independence; ie, you do what you want and I do what want.

Clearly, multiple urologic practice models exist. They can vary based on geographic, political, and demographic variances. The successful model will need to possess a willingness to adapt. The history of urology is replete with surgical, pharmacologic, and interventional advances that have improved the health of our patients. Our specialty has thrived because urologists have continually promoted and accepted a willingness to embrace change and innovation.

The health care landscape is changing for many reasons, including economic constraints, political philosophies, and scientific advancements. As such, urologists must remain flexible and adapt accordingly, so that we can protect our patient’s interests while simultaneously maintaining the relevance and vigor of our specialty. General and cardiovascular surgery have not adapted and have been relegated to performing as mere proceduralists, effectively marginalized by other specialties, and thus see their career opportunities limited to serving as institutional employees.

Urology will move forward as a specialty and embrace the changes before us. Group practice must survive; our profession and our patients require it.

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