Probably no two family physicians work at the same pace. That's natural. It also seems to be an endless source of friction between physicians, of anger and of outright angst. True, in a small group with an “eat what you kill” compensation plan and fee-for-service reimbursement, the problem may not be great. A physician intent on giving each patient “all the time he needs” may just take home less than the partner who sees 50 patients a day — and that partner may profit from seeing the patients his slower associate doesn't have time for. But such groups are becoming less common, and the problems are worsening and becoming more common as groups grow.

The larger a group gets, the more likely it is to measure success by the bottom line of the entire group rather than the incomes of the individual partners, and the more likely it is to have a practice administrator who scrutinizes physician productivity with a manager's eye. Similarly, the larger the group, the more likely it is to have a compensation plan that involves a base salary plus incentives. Where the base salary constitutes a substantial percentage of income, there's a fair chance that the slowest physician in the group won't produce enough income to cover his or her base. Moreover, larger groups are more likely to draw together physicians of differing practice styles — physicians who might not have thought of getting together to form a conventional small-group practice precisely because of style differences. Add in the way continuing pressure on reimbursements increases the relative value of the productive physician to his or her organization, and it's clear that slower family physicians are in for a rougher and rougher ride.

And yes, these slower physicians may well include the ones who are practicing most like the way they were taught in residency — working carefully, taking time to deal with psychosocial issues, getting to know the patient's family, building relationships with patients. That just raises the stakes, since the fundamental nature of family practice may be hanging in the balance.

The solution? You tell us

The problem with this problem, aside from its gravity, is that it has no immediately evident solution, and certainly no easy solution. While Family Practice Management is normally in the business of identifying potential solutions to the problems family physicians face, this is one case where we have to stop short of that.

Our lead article, “Turtles and Rabbits: Family Physicians Under Time Pressure” lays out the issues eloquently, in the words of articulate, thoughtful family physicians who are coping with various aspects of the problem. This time, however, the solution will have to come from you, our readers. Whether you're a “turtle” or a “rabbit,” if you have found a way to make clashing work styles mesh in your group — or if you're just struggling with the issues, too — we would like to know. Feel free to send us a letter or an e-mail. We'll publish selected communications from readers in an upcoming issue.