What’s up, Doc?

When Dr. Dominic Bagnoli Jr. began providing the services of emergency department physicians in 1992, he serviced one hospital.

Three years later, he established Emergency Medicine Physicians Ltd., and today, the Canton-based company provides staffing services to 57 hospitals in 10 states.

EMP supplies emergency physicians to staff and manage emergency departments and manages and provides billing services. With almost 1,000 employees — 250 in the Canton area — and 2005 revenue in excess of $100 million, Bagnoli still keeps his focus on patient care.

“(I try to make my employees) understand that everything we do here in Canton is really supporting the ability of physicians to take care of patients in emergency departments,” he says. “No one goes to the emergency department instead of going out for dinner and a movie. They go to the emergency department because they have an emergency, and 99 percent of the people come there because they don’t know where else to go, or they don’t have anywhere else to go.”

Smart Business spoke with Bagnoli about how he increases his employee numbers through equity incentives and leadership opportunities.

How do you attract the best physician candidates to your company?
We’re the only physician group in the country that we know of that allows physicians to have equal partnership in the hospital contract. The physicians become equity partners — they’re not employees or independent contractors — and that aligns their incentives because they have a true incentive to grow the business and provide high quality care and patient satisfaction, as opposed to being an employee.

It’s the alignment of equity with the physician that allows us to attract the best.

Hospitals will employ the physicians directly, they will contract with a group that will employ the physicians or, in our case, they contract with us and we employ the physicians, but they become partners and receive equity in the practice so they own part of the practice.

We have lower turnover and better alignment of incentives. Young physicians want to be part of a growing organization. Since we’re growing, we always have more and more opportunities, so that allows us to attract the best and the brightest physicians.

They know they can join the group, have a leadership opportunity, and within three to five years, they can be running an emergency department. If they joined a group that wasn’t growing, the opportunity to lead would mean the current leader would have to leave.

How do you retain those doctors?
Physicians practice based on working with a group of other physicians that they like and that they trust. The value of not leaving the group or not moving to other opportunities is that they’re very comfortable.

Everyone had residency training in emergency medicine, and everyone’s a partner. They have an equity position, so they form real bonds with their partners and with the organization because they own part of it; they can’t find that anywhere else.

How do you train them on how your group works?
When we were smaller, it was easy to recruit and hire physicians because they saw the potential and the growth, and they saw that we were different than everyone else. Now that we’ve become so large — and we’re the fifth largest in the country at doing this — we get kind of grouped in with some of the larger groups that don’t give physicians equity and don’t treat physicians equally. The hardest part for us now is to distinguish ourselves from those that don’t run the business the way we do.

We do that by training the physicians and having internal training classes — orientation and a management academy where they learn about how the business of medicine works.

There are a lot of obstacles for an individual practitioner, even a small medical group, to succeed. The most pressing right now is the malpractice crisis. An individual physician or a group of five physicians has nowhere near the capabilities that a group of 500 physicians does because we have the ability to own our own insurance company, to negotiate costs and drive down expenses. As a single physician or a group of five physicians, they’re really the victim of the market.

A big part of that is educating them on why it is better to control and manage your risk, and why it’s important to implement risk management policies and protocols so medical errors are reduced and the quality of care is better.

An employee — whether he is a physician or a nonphysician — works to pay his bills. When you’re an owner or a partner, it’s more than that. It’s easier to do the right things and make the right decisions when it’s part of who you are because you’re just not willing to take shortcuts.

That’s not just in medicine; that’s in any organization or company.

How do you motivate the physicians?
The physicians are owners and partners. If there are profits, they receive a portion of those profits. The employees that we have in Canton, who run the billing and management company, also are on a gain share program where, if the company runs profitably and we reduce expenses, then they share in the profits.

So our turnover is very low because they have the ability to share in the profits of the company with the owners.

Over half of our employees have been here longer than five years; it’s a culture that they understand.

One of the real advantages of practicing emergency medicine is we take care of everybody, 365 days a year, 24 hours a day. Our office never closes. We’re there to take care of patients, and 30 (percent) to 40 percent of those patients don’t have health insurance or are on public assistance.

Our physicians take great pride that the practice of emergency medicine is the safety net of the American health care system. If I can get our employees to understand that they’re helping us provide that care, it really gives them a strong sense of satisfaction that they’re not really processing bills, doing customer service, HR functions or payroll.

What they’re really doing is providing service so that physicians can take care of patients every day. That motivates our employees to feel it’s not a job; it’s really about helping our physicians provide health care.

HOW TO REACH: Emergency Medicine Physicians Ltd., (800) 828-0898 or www.emp.com