Multidisciplinary care: The pros and cons of going big or small

Practices have a couple of options for providing multidisciplinary care to patients: being part of a large, multispecialty practice or adding just one or two additional services to an existing primary-care practice. A recent Medical Economics article examined the pros and cons of each route.

Becoming part of a large, multispecialty practice--the career chosen by about 14 percent of primary-care residents who graduated in 2009, according to the American Academy of Family Physicians--has several advantages for physicians who prefer to work as part of a team rather than autonomously. For example, an administrative group generally handles hiring and firing of employees, insurance contracting and regulatory compliance, while physicians focus on seeing patients. Other benefits include easy access to colleagues for questions and the ability to be involved as little or as much in the business side of practice as desired.

But in addition to the downside of having to give up a measure of control, it can be difficult to arrive at a compensation formula that fairly values all parties. For instance, while specialists may feel they should command higher pay, primary-care providers are essential in driving throughput to their colleagues with special expertise.

Sticking with a small practice that offers a couple of additional services offers unique benefits as well. For example, the Center for Integrated Health Care in Wilmington, N.C., provides patients access to internist Russ Gerry, MD, and six mental health providers under the same roof. "I think it makes for the best overall care we can provide our patients," Gerry says. "I think it's a false dichotomy to split a patient's mental health from their medical health."

One of the keys to patient satisfaction and convenience with all forms of multidisciplinary practices, however, is making providers within each of the practice's disciplines interchangeable from the patient's viewpoint, says Janice Johnston, MD, cofounder of Arrowhead Health, a 25-practitioner practice in Glendale, Ariz.

"All our charts are together, so it doesn't matter if the patient sees a family practitioner or pain management specialist or what have you. Everyone can see what everyone else is doing," Johnson says.

To learn more:
- read this article in Medical Economics