ADVISORY e-ALERT      November 30, 2011 
Advisory Law Group, a Professional Corporation  




Don't worry.  Be happy.  Your future is all planned.


The only problem is that it's been planned by the hospital and you might not like what they have planned for you.


Controlling the Medical Staff


For the past decade or so, hospitals across the country have been making a concerted push to gain control over their medical staff.


They have seeded lockstep medical staff officer promotions with employed or financially compromised physicians.


They have adopted policies such as conflict of interest policies and "side" rules and regulations outside of the medical staff bylaws that, they claim, do not require MEC or medical staff-wide approval.  Those policies permit the administration to remove physicians from practice at the hospital outside of the protections and process of the medical staff bylaws.


Employment/Financial Control


In states allowing the direct employment of physicians, and in others through devices such as foundations and via significant stipend support arrangements, hospitals have sought to buy the cooperation of a significant percentage of the medical staff.  In many cases, their controlled physicians have reached the tipping point such that they outnumber the non-controlled physicians participating actively in medical staff affairs, thus allowing the administration virtual control over the staff while feigning its independence.


ACOs and Physician "Alignment"


Closely related to the previous point, hospitals are taking advantage of society's communal phase of the Me-We CycleTM (see the October 31, 2011 issue of the e-Alert) to create Accountable Care Organization models and other so-called "alignment" structures to gain financial and political control over the members of their medical staff.  Of course, the very clear but seldom mentioned message is that if you are outside of the structure, you will be excluded from any significant financial or professional role in respect of the hospital's community and its referral patterns.


Replacing Professionals with Paraprofessionals


Hospitals are benefitting from the expanding role of paraprofessionals.


Take, for instance, the push by CRNAs to be recognized as equivalent replacement providers of anesthesia services.  Hospitals, seeking to break the financial and medical staff voting block hold of anesthesia groups, are often more than willing to accept CRNAs in place of anesthesiologists.  They view them as cheaper, more controllable and disposable.


Surgeons supporting this move will be shocked to learn that surgical PAs will soon be pressing for the ability perform some procedures unsupervised. 


Dr. Nurse


Doctorate degrees are becoming the top professional degree in many paraprofessional categories.  Once the nurse specialist performing your function becomes a "doctor," you will become irrelevant - or so goes the thinking of hospital-centric healthcare pundits.


What You Can Do


Become involved in medical staff activities.  Only a very small percentage of medical staff members take any interest in participation. 


Lobby hard to preserve the traditional patient-care role of physicians.  Physician extenders are one thing; physician career executioners are another.


Demand that the medical staff has separate, independent counsel, not an attorney controlled by the hospital.


Push for the incorporation of the medical staff to clearly separate its existence from that of the hospital.


Or, you can do nothing and let the future that the hospital has planned for you come to fruition.  After all, you have been guaranteed a choice in regard to healthcare. 




I'd appreciate your input on a new service line I'm planning on offering.

For years, I've been asked to provide a coaching service different from the extremely intensive Immediate Leader ExperienceTM and from the informal, solo approach of the Advisor Program.

My plan is to offer an Entrepreneurial PhysicianTM program to include Success CirclesTM, which is where I need your input.  The Circles would be cohorts of from 8 to 10 individuals, no more than two from any single group.  Centered in part around my expertise and intellectual property developed over the past 30 years, the Circles would be both mastermind groups and informal outside boards of advisors in respect of each participant's group.  There'd be mutual assistance, idea sharing and, importantly, cross accountability.

The Circles would meet in person four times a year.  The Circle member would also participate in four telephone conferences a year.

The pricing would be moderate, with a one time registration fee in the range of $15,000 to $20,000.  There would be an initial assessment and intellectual property provided.  Then, there would be a monthly fee, in the range of $1,800 to $2,500 a month, for ongoing participation.

To my knowledge, there is no program like this for physicians.  It fills a gap, especially in light of the very professional "opposition" in the form of hospitals and health systems.

What do you think?  Note that I am NOT asking anyone to sign up or to commit to anything at this time.  All I'd like is your thoughts on my plan.  My personal email is
Thank you.

Avoid The Most Common Mistake Concerning Competition   


View Episode 35 of the Wisdom. Applied Videocast 





I recently read that taken together, the value of all airline shares from the beginning of the industry to date would be a net loss.  Is anyone surprised?


On two recent connecting flights on the same airline, the customer experience was so wildly different that you'd think they were not only different companies, but on different planets.


The first plane was shabby, with a torn seat and service to match.


When the woman across the aisle asked for a ginger ale, the flight attendant retuned with a tray of drinks, and stopped in front of her.  "Is this ginger ale," the passenger asked.  In response, the flight attendant scowled, "well, that's what it looks like to me," when a simple "yes," would suffice and a simpler "yes, ma'am" would have thrilled.


The second plane is spotless and the service is excellent.  But what do I remember?  The bitchy employee on flight number one, and she wasn't even talking to me; I just had to bear overhearing it.


You should have guessed by now that I'm not writing this for airline executives - I'm writing this for medical group leaders.  On a daily basis, your group's physicians are likely delivering widely varying experiences to the group's patients and perhaps to their families as well.  They are also likely interacting very differently with referring physicians and others.  Why?  What will the blowback be in connection with your next negotiation with a facility?  What referrals will you miss?


With many, many years devoted to medical school and then to post-M.D. training in the performance of the technical side of delivering patient care, you'd think that groups would be sensitized to the need for training in the interpersonal and communications skills that support it. The fact that this is not the case makes this the case for your group to implement it.


Hardly any of your colleagues at competing groups have any understanding of what I'm talking about.  Fewer still will do anything to implement it.  That's why, for you, it will be like shooting ducks in a barrel.


What behaviors are expected by the group?  What phrases have you tested?   These are but a few of the questions that you need to start asking and then, when you have the answers, implementing.


In fact, ask yourself right now, is your group run as poorly as an airline? 


How Scenario Surveys Strengthen Strategy, published in the September 2011 issue of Pain Medicine News and in the October 2011 issue of Anesthesiology News.

Scenarios Can Shape Group Strategy, published on on August 24, 2011. 


To read other recent articles, click here 



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ADVISORY LAW GROUP, a Professional Corporation

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The materials presented in this Advisory e-Alert are educational only and are neither legal advice nor a substitute for it. Advisory e-Alert presents a general discussion which may or may not apply to your particular legal or factual circumstances. The distribution of Advisory e-Alert is not intended to create, nor does it create, an attorney-client relationship. Please do not send us confidential information without receiving explicit authorization from Advisory Law Group to do so. Do not take or avoid taking any action as a result of the materials presented in this e-Alert without first obtaining legal counsel.   
2011 Advisory Law Group, All Rights Reserved


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Avoid The Loss of Your Practice in 2012:
An Introduction to the Practice Protector ProcessTM
2012 will bring an increase in medical group failures as hospitals and predatory national groups, facilitated by government regulators, continue their onslaught against traditional private practice.
Your future as written by them:  Employment as a fungible, commodity-based provider.
If you'd prefer writing your own future, take 30 minutes to learn about The Practice Protector Process, designed to help you preserve your practice, your patients and your profits.


When: January 11, 2012 

Time: 4:00 PM PST 

Length: 30 minutes

Complimentary for e-Alert readers


Click here to register today!

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Let Us Know What Business/Legal Issues You'd Like to See Addressed in A Future Issue
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In This Issue
Don't Worry About Your Future - The Hospital Has it All Planned
I Need A Favor: Please Provide Your Input
Videocast: Avoid The Most Common Mistake Concerning Competition
All Things Personal
Recently Published Articles
The e-Alert Archive
2011 Anesthesia and Radiology Business Updates Now Available
The Wisdom. Applied. Blog
Q & A Video Series
The Immediate Leader Experience
Mentor Program


Listen and subscribe to Mark's podcast series, Wisdom. Applied., now on iTunes.










Whether you're an anesthesiologist, a radiologist or another hospital based or office based physician, there's tremendous value waiting for you in your complimentary copy of Advisory Law Group's 2011 Anesthesia Business Update and 2011 Radiology Business Updates.

Click on the images below to access the download page.   
2011 Anesthesia Business Update   

2011 ALG Radiology Business Update

Follow this link to Mark's blog, Wisdom. Applied.


Overhear Mark's responses to medical group strategy and business questions.
Follow this link to the
Q & A video page.    


You're a physician who wants to form a medical group and, among other things, subcontract with or employ other physicians, enter into exclusive contacts, obtain significant stipend support money, create related entities to increase protection and the like. And you want to come up to speed on all of this immediately.

Or, you're the new leader of an existing group with complex practice and business operations -- you need to understand how to master the group's organizational, operational and leadership issues -- and you need to be brought up to speed immediately.


After having regularly dealt for many years with physicians in both of these contexts, we've designed a process to deliver immediate results: The Immediate Leader Experience™.


The Immediate Leader Experience™ takes place over a weekend in Santa Barbara, California and includes two nights accommodation at the Four Seasons Santa Barbara Biltmore Hotel. 


In two short days, you'll be entirely up to speed, totally prepared and confident.  You'll be armed with tools and sample documents.


Due to the nature of this program, admission is upon interview only -- there is extremely limited availability.


For further information on The Immediate Leader Experience™ follow this link.   
For information on Mark's mentor program, click on the following link:  The Advisor Program.