Practicing Excellence: A new beginning for laid-off docs

It was January 2003, and the family physician from Livonia, Michigan, had been called to what he thought was a routine meeting with other primary care doctors from the suburban Detroit hospital. Instead, an administrator announced that Providence was "divesting" its network of revenue-losing outpatient primary care physicians.

"Explain this term divesting the network to me," a stunned Deighton remembers asking. "Basically, they told us we were going to be on our own."

"That was the first I had ever heard any rumors of this occurring," Deighton says.

For the first time in his 12-year hospital career, Deighton had a choice to make: In six months, he could either go solo, find another employer, or unite with other physicians to launch their own practice. To Deighton, it seemed, there was strength in numbers.

Risking their personal savings for a multimillion-dollar credit line, he and 30 of Providence's family physicians and internists formed Infinity Primary Care, a seven-office practice northwest of Detroit. Since launching in summer 2004, Infinity has added two locations, 11 more physicians, a diagnostic center with a CT machine, and a family medicine residency program (to learn more about the program, see "An infinite future" on page 13).

But Infinity was no overnight success. Deighton and his co-founders met weekly for months to get to know each other, consult with experts, and learn the differences between running a small business and collecting a paycheck from a hospital whose parent company, Ascension Health, is a $13.5 billion nationwide health system.

BUILDING TRUST

Deighton emerged as the group's leader in early organizational meetings, which took place while the doctors were still employed at Providence. It wasn't the result of any formal process, but rose out of the fact that he was the one who scheduled the meetings and who bridged the differences between family physicians and internists.

"It took some time for [the internists] to realize that the family physicians do know how to practice medicine and for us to see that they can do a good job for their patients," jokes Deighton, a tall, imposing figure with a surprisingly soft tone and quick wit. The Michigan native volunteers at a free clinic and leads medical missions to West Africa with his church group.

Deighton's earliest challenge was in earning trust among the group's physicians, each of whom were putting their financial well-being on the line. The frequency and openness of meetings was crucial to building that bond. They called on management consultants, attorneys, and financial experts. After months of deliberation, the physicians unanimously agreed to stay in the seven independent offices they had used while working for the hospital, and employ an "eat what you treat" model, as they call it. Each office, or "pod," distributes profits based on a median revenue production level for the specialty; if a physician produces 90 percent or more of the median, he shares in the pod's profits.

"It was like getting an MBA over that year and a half," says David Steinberger, MD, an internist who is also the medical director of Infinity's diagnostic center and secretary of its leadership board. "The business side was clearly the hardest thing to learn-how third-party payers actually work."

Once the practice was on its feet, the physician-owners selected a seven-member board and voted Deighton to the top post.

"It became clear that he was the best person to lead the group," says Steinberger. "When we looked at our available options, he was the best option. And he's done just a tremendous job. Leading a large group of doctors is almost impossible."

And Deighton, it seems, might have known that from the start. "It was not my intention in any way to become president," he laughs.