Obstacles to Effective Medical Group Governance

ObstaclesIn earlier articles I discussed some of the obstacles to implementing effective medical group governance:

Why Is Effective Governance So Hard to Achieve?

We believe there are several other reasons that medical groups have a tough time developing and implementing effective governance:

  1. Desire for autonomy: Most physicians have a high desire for autonomy.  Many want all the benefits of sole practice in a group practice setting.
  2. Mistrust of organizations: In our experience, many physicians have a general mistrust for organizations.  They often wonder “is the organization here to help me achieve what I want, or to thwart me?”
  3. Paranoia: There is some naturally forming paranoia in medical groups – if the group has a Board, the shareholders sometimes wonder “are they in there doing something for me, or something to me?”
  4. Peer relationship: Often the thought is an owner is an owner is an owner – who is anyone to tell anyone else what to do, how to act, etc?
  5. Confusion: In many groups physician confuse ownership and governance – they feel that, as owners, they should have a say in all decisions. While this may work for a smaller group, it becomes problematic as groups grow.

Dysfunctional Governance Structures

Left to chance, many groups fall into one of four dysfunctional governance structures:

  • One physician calls all the shots.
  • Can be successful over the short run, but there are major risks:
  • Dictator may not be so benevolent.
  • Group may grow, but only with “followers.”
  • When the dictator  leaves, there is a  leadership void.
All Must Have Their Say
  • Everyone must be involved in every issue, no matter how minor.
  • Leadership lacks the will to make decisions because they don’t want to be “criticized” or “second-guessed.”
  • Meetings last an eternity.  Every issue (no matter how minor) must be hashed and re-hashed.
  • Decisions are re-visited over and over again.
  • In reality, these groups will not implement decisions when votes are close.
Unanimity At All Cost
  • These groups kid themselves into thinking that if they can just get everyone to agree to a course of action that it will actually be implemented. Unfortunately, it usually doesn’t work out that way.
  • Unanimity is required before any significant decision is made – this is impossible in practices of more than one physician.
  • No significant decisions are made, opportunities pass by, the wrong people leave.
  • No organized structure.
  • Hope is the key strategy for these groups.
  • These groups avoid all decisions that might cause conflict or require decisions to be made by the group.

The Cost

As you might expect (and possibly have experienced) there is a cost to this dysfunction:

  • There is a lack of focus on a vision for the group.
  • Broad powers are reserved for the shareholders and everyone has to be involved in every decision – there is a lack of followers!
  • Unanimity is required in every decision.
  • Issues are discussed ad nauseam.
  • There is an over-emphasis on representational leadership.
  • There is an over-emphasis on protecting the rights of every individual.
  • Responsibility is given, but without needed authority.
  • Issues are brought up over and over again – there is tyranny of the minority.
  • There is confusion over the difference between ownership, governance and management.
  • Decisions tend to be based on the personalities rather than principles.
  • Only unimportant issues get resolution and the group spends little (if any) time focusing on strategically important issues.


So, what can be done?

Establish an effective system of governance as outlined in our future articles.



Please contact me if you’d like to discuss this post.

Will Latham

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