Shall we dance?

PHOTO: Shall we dance?

The success of partnerships in human endeavours, and these include medical practice, depends on the individual needs and personalities of the participating individuals.

Some doctors work in pairs, like my partner and I. This works well for both of us. Whenever I am not available, my partner will see my patients. And vice versa.

But ours is a simple, straightforward arrangement. Some would say it is working out so well because there is negligible financial implication. He collects the fees of the patients he sees (his, and occasionally, mine), and ditto for me.

Fortunately, we share the same approach to patient care, and our patients don't really mind if they see either one of us.

Two of my colleagues dance a pas de deux that is as rare as it is refreshing. I would almost say ennobling, but that would be putting a moral value on it, which is something I avoid. More of that later.

Dr G had had a successful private practice for close to 20 years when he invited Dr M to be his partner. From the first day of their partnership, 50 per cent of Dr G's earnings went to Dr M, and the same went for Dr M's earnings.

No questions asked, and no looking over each other's shoulders.

Initially, Dr G was seeing 40 patients a day, and Dr M's daily load was in the single digits. As a result, Dr G's earnings went down, and Dr M, seeing far fewer patients, was earning as much as Dr G. This has now gone on for two years, and both doctors have been happy all this time with their arrangement.

As I write, Dr M's patient load has picked up considerably. Both Dr G and Dr M also have the advantage of taking time off (like my partner and I) without jeopardising patient care, and they feel good about their "equal" status. They tell me that their psyches synchromesh.

This arrangement will not work for most doctors. To them, this sort of arrangement takes too much of "bear and grin" in the first few years. Worse still, the imbalance of work and remuneration may even last a decade.

Money matters often lead to misunderstandings. Some doctors, after having tried "partnerships" (duos, trios, quartets, etc) prefer to go it alone. It works better for them.

Not all can be team players

I know of groups of doctors who are "partners" only in as far as purchasing drugs and equipment is concerned. This is because of economies of scale.

Four doctors I know call themselves a "group partnership", although the only thing "partnership" about them is the "name" they inherited when they bought a successful practice. The name was a good brand. The doctors work in different premises with their own staff. They individually earn their keep.

Occasionally, a successful group practice (20 or more doctors) will work out a complicated profit-sharing scheme depending on whether the doctors are senior partners, junior partners or associates. They have taken a leaf out of the way lawyers and accountants set up their partnerships.

What arrangement would I consider the "ideal" private oncology practice? Ten to 15 oncologists (this also applies to other medical specialties) set up an oncology centre. Financial and intellectual resources are pooled. Paramedical personnel (managers, physicists, oncology nurses, therapeutic and imaging radiographers) are hired and work with all the doctors.

Expensive and well-maintained radiotherapy and radio-diagnostic equipment are possible, whereas it would be outside the reach of only one or two doctors. Subspecialisation is possible. Continuing medical education programmes can be organised. Clinical trials can be conducted, and trial findings can be presented and published.

Unfortunately, the picture I painted is still a pipe dream in our country, but it is already happening overseas.

Some work better alone, others prefer a partner, and others still are happier in a large team. There is no right formula. How our competitive/cooperative genotype is expressed in our thoughts and deeds is something we have little control over.

It is tragic when we go headlong into the "correct" arrangement only to find we are not suited for it. Much time, effort and energy would have been wasted.

Not all of us can be team players. Some who have a mild form of Asperger syndrome or are introverted would get more and more uncomfortable as the number of partners increases, and with that, more human-human interaction.

In any case, extroversion is overrated. Extroversion, sociability and gregariousness are just a mental make-up. Introversion and a reflective attitude are equally prevalent.

Be creative. Go beyond writing an essay, painting a picture or composing a piece of music. Think of a new partnership arrangement never thought of before.

Look for that "ideal" (note the quotation marks) partner or partners who are in sync with you. Or if you would rather do things your own way, then go solo.

To some, the advantages of being in a group practice cannot make up for the freedom and joy of doing things their own way. Whatever it is, be comfortable in your own skin.

Whatever works for you, works.