Examining Physician Groups: Beyond CMGs

Emergency physicians are experiencing burnout at an alarming rate, three times higher than the average doctor. Many attribute this burnout to the corporatization of healthcare by contract management groups (CMGs), which they claim interferes with the physician-patient relationship and undermines the specialty. Angry posts in the popular Facebook group EMDocs denounce CMGs as malevolent entities. While some of the resentment is justified, it is important to critically evaluate the situation and move beyond scapegoating CMGs.

The term CMG, or contract management group, is often thrown around without a clear definition. It is used to describe large physician groups, but the size limit for what constitutes a CMG is unclear. Is a group with five contracts considered a CMG? What about ownership? Can a non-profit academic group that manages multiple contracts be categorized as a CMG? The lack of clarity surrounding the term CMG makes it an ineffective boogeyman for the issues within healthcare.

Shift the Focus to Strategy

Instead of fixating on the term CMG, emergency physicians should shift their focus to examining the strategies employed by their physician groups. The questions they should be asking are: Who leads the group and determines the strategy? Are physicians treated equitably? How is compensation structured? How does the group prioritize quality of care? How are patient issues handled? How are advanced practice providers (APPs) utilized?

One crucial aspect to consider is the leadership of the physician group. Physician-led organizations tend to prioritize strategies that benefit physicians and patients, avoiding harmful practices such as out-of-network billing, lawsuits against patients, and sudden contractual changes. In contrast, groups owned by non-physicians or arms-length investors may prioritize financial gain over the well-being of physicians and patients.

Physicians deserve fair treatment and compensation within their groups. Wage and shift preference should be distributed equitably among physicians, avoiding historical disparities seen in specialties like academic departments. Due process should be in place to address clinical issues and conflicts, while non-compete clauses should be avoided to foster a more physician-friendly environment. A transparent assessment of compensation, including factors like clinical pay, bonuses, benefits, and education support, is crucial for physicians’ well-being.

Transparency and Financial Health

An essential aspect of evaluating physician groups is understanding their financial health and transparency. It is important to assess whether the group has a cautious and disciplined financial strategy or if they prioritize profit over other considerations. Financial performance should be communicated transparently to frontline physicians, ensuring they have a clear understanding of the group’s financial standing.

Emphasizing Quality of Care

One of the key factors that differentiates physician groups is their approach to quality of care. Assessing whether the group utilizes evidence-based clinical tools, prioritizes patient safety, and provides real-time support for physicians in high-risk situations is crucial. The feedback culture within the group should also be examined to determine if it is constructive or punitive, as positive feedback and effective feedback programs contribute to enhancing the quality of care.

Patient-Centered Approach

How a physician group handles patient issues beyond the acute care visit is crucial. Instead of resorting to lawsuits against patients who can’t pay, groups should explore patient-centered approaches to address payment issues. Following up with patients after discharge to assess their recovery, address care issues, and ensure appropriate follow-up care is provided can significantly contribute to patient satisfaction and overall healthcare quality.

The role of advanced practice providers (APPs) within physician groups is an important consideration. The quality of APPs should be addressed, ensuring they work collaboratively with physicians and have access to real-time communication. Standardized training and adherence to established physician-established standards is essential for the effective utilization of APPs. Differentiating the schedules and treatment of physicians and APPs can lead to disparities within the group and should be avoided.

Moving Beyond CMGs: Judging Groups by Strategy and Performance

To accurately assess physician groups, the focus should shift from categorizing them as CMGs or otherwise and instead evaluate their strategy, performance, and treatment of physicians and patients. Categorizing groups based solely on structure is misleading, and it is crucial to gather accurate and reliable information by engaging directly with group leadership and physicians working within the organization. By asking the right questions and holding them accountable, physicians can gain a deeper understanding of a group’s values and practices.

It is essential to move beyond the scapegoating of CMGs and instead critically examine the strategies, leadership, and practices of physician groups. By focusing on equitable treatment, fair compensation, transparency, quality of care, patient-centered approaches, and effective utilization of APPs, physicians can make informed decisions about which groups align with their values and prioritize their well-being and the well-being of their patients.


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