The Organizational Structure of a Multi-Specialty Clinic

Multi-specialty medical clinics group physicians from different specialties under one roof. This organizational structure allows physicians to take advantage of the efficiencies of centralized management, a smaller support staff and discounts for ordering larger quantities of supplies. A multi-specialty clinic also appeals to patients who appreciate one-stop shopping for medical care.

A multi-specialty clinic usually adheres to one of two models: one in which the physicians are partners in the business, and one in which a larger entity such as a hospital owns the clinic and the physicians are employees. If each physician owns a share in the clinic, the physicians together manage the business, voting on major purchases, setting prices and other decisions, and splitting the profit. Clinics owned by an outside business sign the physicians to a contract. The doctors receive a salary, and may also be eligible for bonuses if the clinic meets certain revenue goals.

Physician practices made up of one or more physicians in the same medical specialty rely on other doctors to refer patients to them. Usually, referrals come from primary care physicians such as family practice doctors, internists and pediatricians. In a multi-specialty group, especially one that includes primary care physicians, the member doctors refer to each other. This guarantees a steady supply of referrals. Group purchasing allows the group clinic to acquire supplies more cheaply. They also need fewer employees than the same number of doctors operating individual practices, since functions such as appointment setting and insurance filing are centralized. Group practices also have greater buying power to acquire expensive diagnostic equipment such as X-ray and ultrasound machines.

The physician members of a multi-specialty group may each have an equal share of the business and an equal say in how the clinic is run, or they may each own different percentages. Senior physicians may have a greater say in decision-making and may enjoy a greater share of profits. A corporate-owned clinic will have a board of directors or management group to oversee the clinic. Both physician-owned and non-physician-owned clinics will employ a clinic manager. Some will have separate business and medical managers. A larger clinic will have different people in charge of personnel, finances and medical operations.

Physicians who work for a multi-specialty clinic have to give way to others’ decision-making authority when they are employees of the clinic. Even if they own a share in the clinic, they have to abide by majority rule. The performance of other doctors may affect the share of profits they receive. Physicians in multi-specialty groups may have to share on-call duties. The group has to approve major purchases or policy changes, which can frustrate doctors who like to make their own decisions.