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Richard J. Levy, MD, jokes about the absence of any epiphany leading him into his field.field.
“What made me want to go into medicine is completely unclear. All of my life, as far back as I can remember, I wanted to be a doctor. I suspect it was in utero programming by my Jewish parents.”
Whatever the impulse, it bore fruit. Levy is President of the 40-physician practice, Oncology/Hematology Care, Inc., of Cincinnati, Ohio, which serves patients in a three-state area. According to Levy, there was no master plan. In fact, when he was a medical student at the University of Cincinnati, he expected to enter academics. Then, in 1971, he accepted a fellowship at the Scripps Clinic and Research Foundation in La Jolla, California.
“My sights were still set on an academic career, and I spent 4 years doing bench research at Scripps with a brilliant guy named Richard Lerner.” [Editor's note: Richard Alan Lerner, MD, was at that time a member of the departments of Experimental Pathology and Immunopathology. Later, he would be named Director of The Scripps Research Institute].
“At the end of that time I decided that basic research wasn't where I wanted to spend my career, so I looked for something in internal medicine that would overlap my research interests. That turned out to be medical oncology, which at that time was a relatively new specialty,” said Levy.
“I practiced in San Diego for about 5 years, doing general internal medicine and medical oncology. Then I came back to Cincinnati, and did a residency in radiation therapy.
“I went into solo practice in Cincinnati doing both medical oncology and radiation oncology. Cincinnati was sort of a backwards stop in the oncology world, and before long, I was too busy. I needed coverage and partners to help with the volume of work. I recruited a medical oncologist and a radiation oncologist, and I'm happy to say that Mike Neuss, the medical oncologist, is still one of my partners.
“The knowledge of medical oncology was exploding, and a few years into practice it became clear that I had to choose between that and radiation. I couldn't go on doing both. So I settled on radiation oncology. This was really the beginning of our practice. There was no grand design to build a big practice, but there are now 40 of us.”
JOP: Apparently you made the right decision. Most businesses the size of yours, evolve by way of a formal management structure. Several that we've interviewed even use 5-year strategic plans.
We don't have a strategic plan, but we do have a dual underlying approach. One is to take really good care of patients. That has turned out to be a good business strategy. The other is to try and be smart about how we manage our business.
JOP: Those two rules sound deceptively simple.
Actually there's a third guiding rule: to not have much overlap between the other two. When a patient is being seen by one of our doctors, we don't want the physician thinking about business. We all agree we want to be guided by what is best for the patients.
JOP: And how do you reach consensus in such a large practice?
Slowly. The group's success has led to a fair amount of support for me, and [support for] the more senior people. It is generally assumed that we will try to do the right thing. I was being a little flippant when I said “slowly.” Most of the time, our judgment about what's good for the practice [receives support from] the partners.
JOP: Is it a general partnership?
JOP: So conflict really isn't an issue.
It hasn't been. We've been very lucky.
JOP: And how do you approach the capital decisions that will have a financial impact on all of the partners? You know: mergers and acquisition, capital equipment, entering new lines of business?
We use several strategies. We meet, we use voice mail, and we use e-mail. And pretty much, we get to consensus without a lot of trouble, almost all the time.
JOP: Is your practice managed internally?
Yes. We have a CEO who's trained in accounting and was a lawyer. And I'm the President. I see patients about two thirds of the time and help out with management the other third.
JOP: What process do you use to hire new associates?
It has evolved. One of our managers has great people skills, and she helps find people, takes care of scheduling, etcetera. When we were smaller, everybody would interview the person, and everybody had a blackball. We required 100% agreement to have somebody join. We'd have a cocktail party for them and their spouse, and everybody was involved. But as the practice grew, this got to be unwieldy. So now we bring people in and select various partners to interview them.
JOP: And that works?
JOP: Your practice actually covers more than one state. Does this present any governance issues?
Not that we know of. Anyway, that's sort of misleading. Cincinnati is located on the Ohio River. Kentucky is across the river, and Indiana is a short distance to the west. So it's not as if we're flying from office to office and trying to grow into distant markets. The area we cover is the Cincinnati metropolitan area.
JOP: Your associate, Michael Neuss, MD, has been a leader in ASCO's Quality Oncology Practice Initiative (QOPI). Have you implemented that in your practice?
Yes, we're one of the QOPI practices.
JOP: How have the physicians received and acted on the information?
You know, it's too early to tell. There is a lot of affection and admiration for Mike, but like all doctors, anything that's a change is tough.
JOP: Your practice has both radiation and medical oncologists. Does that present any issues in regard to equity in compensation or governance?
It's never gotten ugly, but it obviously produces issues. We've solved [them] by trying to make it so that everybody is advantaged by being in the group.
JOP: Do your radiation doctors practice at group-owned facilities?
Both at group-owned facilities and at hospitals.
JOP: So the hospitals in your area have their own facilities for radiation therapy?‘
Almost all of them do.
JOP: So how do you deal with potential competitive issues?
Badly. We try and work cooperatively, but we have the belief that physicians are the indispensable part of the medical food chain and that hospitals, not physicians, are the commodity. This has led to our being popular in some hospitals, and unpopular in others.
JOP: Looking back, do you see any particular milestone in the development of your practice?
The one thing that I'm proudest of? When it came time to add people to the group, I consciously thought about how comfortable it would feel to hire people who weren't as good as me. I overcame that temptation, and made it my goal to stay the dumbest person in the group. I've largely succeeded. We've always attracted people based on quality, and that has been a good strategy.