Collaboration in Larger Practices

In addition to all training it might be wise to also look at alternative forms of more relevant collaboration between practitioners including the formation of practice groups or the creation of HCCs to make use of centralized structures. Looking at Hungary, the work in bigger teams brings major advantages which may support raising the per practitioner profit in practices in Germany as well. This research clearly indicated that HC practitioners in bigger practices are generating larger revenue. Considering that fact in combination with knowing where exactly the challenges are that practitioners face, and with clear solutions to make such work possible, bigger practices seem to be a viable direction. The FG, however – maybe due to sample size or age of its members – was strictly against such larger structures. No matter the potential financial gains that could be created, the practitioners in the FG preferred avoiding the potential struggles that might arise due to the required communication process and the challenge potential arising from such ownership connections. One reason for this struggle could be, that this type of collaboration requires equality and relationships based on trustworthy communication that result in common agreement. Practitioners, however, study to develop a very strong own opinion based on facts and are trained to defend this opinion.

Compromise is not what these individuals are trained for, and thus, collaboration based on mutual agreement might be hard and challenging. It seems that if communication skills eventually would form part of the curriculum and if these individuals were trained in developing business consensus and agreements, then such collaboration could become more likely – however, this rather is an assumption than a real outcome of the study. Still, three of the five practitioners in the FG (unluckily all FG members were beyond forty years of age) agreed, that the right training might facilitate such options and make more complex and interconnected forms of collaboration a viable opportunity. In fact, younger practitioners – so reveals the survey – are more likely to be organized in bigger teams and in group practices than younger ones, which makes believe that younger practitioners already understand the

advantages of practice-/staff-/device-sharing, that the more experienced practitioners in the FG value significantly lower than the liberty of free decision-taking, that seems to be valued with age. PUS2 (female, 40-50 years) in the first round of interviews explained she would never consider any form of group practice. In her – as she called it – current life phase she looks for other practitioners to pursue practice sharing. An option, to practically rent out the furnished rooms with profit at her closure times / or even adapt the own opening hours to opening needs of another practitioner to be willing to use her rooms. A system as the suggested is similar to a group practice – meaning that there is no obvious legal connection between the different practitioners and that every practitioner has his own accounting to settle accounts with his very own patients.

When considering that the use of CI or the use of online recommendation platforms lead to significant revenue increase, then it turns out that collaboration may play a major role in generating a lasting enterprise. Given that collaborating practitioners can use not only outsourcing but also insourcing to increase their revenues, these all might be viable structures to create an enterprise with lasting profits. Further, the collaboration in a bigger practice might bring practitioners with different qualities to the table which as a consequence might be able to all add special qualities to the team and improve the marketing position even further.

The potential of such action is manifold. Another advantage can be found in recruiting.

When working in a bigger team – the fees recruiting agencies may charge (one of the big revenue drivers according to survey results) – can be negotiated more easily which might increase profits. Such collaboration can be organized in three major ways: the group practice in form of a civil partnership owned together, the group practice in form of several sole proprietorships, owned one by one, with some commonly-used features or the structure in form of an HCC with several owners. Either one of the three options come with advantages and disadvantages that are shown in Table 9. The author does not claim for the table to be complete. It is a listing of points that came out of the focus group discussion and that was complemented by logic counter-arguments, however not by existing publications. The following paragraphs mention a range of comments about the table. Nevertheless, due to the limitations of the study not all arguments visualized in the table are fully explained in the text.

First and most common of the options of collaboration are the civil partnership. This model so the FG is common and viable for married couples. It would also be an option for

business partners, however, trust over time might become an issue. Therefore, a civil partnership can be an option, though all potential consequences must form part of the consideration. The so-called group practice intends to combine best of both worlds – single practice and civil partnership – and thus seems to be a viable alternative to the civil partnership. If well implemented it can have major advantages, however, at least in the FG the practitioners seemed not to be particularly aware of the details of this form of settling.

The HCC for the practitioners in the FG was only discussed if implemented in form of a GmbH – meaning a limited liability company. Here the most significant disadvantage to the FG was the giving-up of the freelance status. The reputation of this opportunity to the members of the FG was so low, that none of these members would consider it.

Table 9: Advantages and Disadvantages of Different Forms of Collaboration

Advantages Disadvantages

- Common personal liability for all owners

- Personal liability for own decisions

- Common personal liability for any contractual agreements - Employment of an endless

number of doctors

- Common ownership possible - Personal liability limited to

medical director and CEO - Possibility to employ more

doctors

- Giving-up of freelance status - Bad reputation amongst

practitioners

- Limited knowledge about facts

(Own Development)

It turns out that collaborations in different forms are a possibility in Germany’s modern HC system. Most of these have significant advantages which, however, by practitioners are often not used, due to lack of knowledge. Even though not initially mentioned by the

practitioners in the training part of the FG discussion, the collaboration part reveals, that knowledge about company structures and forms of establishment must form part of future educational programs to make sure that potential new founders choose amongst all options they have and thus – as a consequence – lead their company to their personal definition of achievement and success.