This BC group fell in love with an expansion plan they thought couldn't miss. After all, they had the perfect person in the driver's seat � until the wheels fell off.

By Theo Sands

Three years ago a seven multi-specialty group in a suburban centre in BC's lower mainland decided to make substantial changes. The practice had run well for 13 years. Physicians had come and gone but a core of four had been there since the beginning. They credited a good partnership agreement to start with and flexibility on members part for their success. Over the years they felt they'd seen it all � conflicts over hours worked, vacations, compensation, off-hour coverage, buy ins and outs � and they were still in business. The staff of 12 was reliable and reasonably content, turnover was low � five of the original employees were still with the practice.

The area where they were located had grown significantly. The population, once primarily middle to lower income families in single dwellings were aging. New highrises had attracted a large number of younger people who commuted here because the rents were lower. At the same time a developer had attracted a large number of affluent immigrants to the three gated-communities he built. There was a new high school, an elementary school and a community centre, along with two huge new shopping centres and a small downtown area that was being revitalized. The group decided it was time to take advantage of the changing times.

The momentum for change came from one of the original members and an ambitious family physician in her early 40s who, prior to joining the group, worked in Edmonton and had acted as a consultant to the Alberta government on healthcare reorganization. Though supportive of universal healthcare, her father was a successful promoter in the oil business and some of his entrepreneurial spirit had rubbed off on his daughter.

The idea � worked out over six months' worth of twice-a-week evening group meetings � was to build a new clinic, bring in five new doctors, increase the staff to about 25 and hire a full time practice manager. The vision was that, when fully implemented, the number of patients would more than double, income of group members would increase about 20%, the practice manager would take the administrative burden's off the doctors, and the group would have equity in a valuable and appreciating real estate asset. A bank would provide funds for the expansion.

Given the excellent credit rating of the individuals and the solid financial history of the group, it was anticipated that raising money wouldn't be an issue. On that score, the physicians were right. Much of the rest of the vision came apart at the seams. It was a gradual process � and was painful to watch. Some of the challenges were predictable � the building had a large cost overrun and was five months late in completion; the first manager the group had hired quit after three months; good staff was hard to find and they lost six of the old employees in the process. What the group didn't reckon with was more important � leadership.

TAKING THE LEAD
Impressed by the initiative, energy and go-get-it attitude of the Alberta FP, the doctors let her take the lead. She'd convinced them to go ahead; clearly she was the person for the job. When let loose on the project, though, she showed quite a different face to the contractors and other suppliers she hired in the group's name. During review meetings with her colleagues she was the picture of a calm, capable and clear-headed project manager. They trusted her. With everyone else she dealt with she was demanding, picky and unforgiving. Short tempered, she made enemies quickly which, unbeknownst to the physicians, was the principal reason for the cost overruns and the delays. Suppliers are one thing, staff was quite another. Her abrasive, arbitrary way of doing things quickly antagonized the employees who were crucial to the success of the venture. To her face they were sweet and light but behind her back they made straight armed salutes and called her Dr Hitler.

The crisis came to a head a week before the move to the new premises when the office administrator and most senior employee, who members of the group adored, asked for a private meeting with the doctor who had been hired 16 years before. In a tearful conversation she said she simply couldn't work with Dr X and wouldn't be making the move.

IN THE END
The group survived though but it has yet to flourish in the way they envisioned 36 months ago. They have added two doctors and as a whole are seeing more patients, though not nearly the 50% they once envisioned. They've rented some of the extra space to a dentist and an insurance broker. The second practice manager couldn't be financially justified given the burden of the mortgage and the doctors are, once again, directing their own ship. As far as they know, the catalyst that began all this is back in her home province � in a solo practice.

There is one bright spot. The real estate turned out to be an excellent investment.