Michael-Anthony “M-A” Williams, MD, FHM, thought he had his future mapped out. After completing his residency in 1999, he joined Inpatient Services, PC (ISPC), in Denver with the intent to practice for a year and use his experience as a bridge to a fellowship or other professional opportunity.
The plan changed, however, when the IRS informed his HM group it owed $450,000 in unpaid payroll taxes, and banks began threatening to freeze accounts. After the dismissal of the group’s business manager for malfeasance, Dr. Williams offered to help. He took over as the practice’s financial officer, reconstructing two years’ worth of records and negotiating a compromise with the IRS.
The successful crisis resolution left Dr. Williams reassured that ISPC had a viable business. It also laid the foundation for his journey into HM leadership. He took over as the practice’s president in 2003. Four years later—after helping grow the practice from 16 physicians and 46,000 annual patient encounters to 38 physicians and 84,000 annual encounters—he helped orchestrate a merger with Tacoma, Wash.-based Sound Inpatient Physicians. He now serves as Sound’s executive director of business development.
“When I became financial officer, I didn’t know what P&L stood for,” Dr. Williams admits, referring to the common business jargon for a profit and loss statement as an example. “It really was an education from the ground up. But the reason I got involved in reconstructing the books in the first place was because I was interested in how the business of hospital medicine worked. That experience has served me well.”
Question: When you took over as president of ISPC, did you have a sense the growth would be so rapid?
Answer: We didn’t necessarily plan to continue to grow, but every time we turned around at a hospital, more primary-care doctors were asking us to take over their patients. It’s not something we actively sought. The business came to us. Before long, we realized the growth probably wasn’t going to stop.
Q: What prompted the merger with Sound?
A: It came down to infrastructure and support. We knew more growth was coming, and we were in a position where we needed more professional leadership. I wasn’t going to be in a position to do the president’s job forever, and we didn’t have other physicians necessarily clamoring for the opportunity. At the same time, we were very cautious. We wanted to make sure we merged with the right group that was physician-led.
Q: Three years into the partnership, what have the benefits been?
A: It has brought a lot of stability. There’s not that month-to-month worry the partners may have had about cash flow and how the business is functioning and what our health insurance premiums are doing, which were constant discussions before. And we have much stronger relationships with our hospital partners. That has allowed our doctors to get off the encounter treadmill. The biggest impetus for joining Sound was to provide a better workday for the hospitalists, because we kept seeing the encounters climbing higher and higher against our wishes.
Q: Have there been any unforeseen challenges?
A: The biggest challenge for those of us who were partners was ceding some control. It’s been a tradeoff. It’s been worth it to lose some control but gain a better workday and a little more stability.
Q: What advice would you give to someone whose group is going through an organizational change?
A: Thoroughly explore all of your options. Don’t be afraid to take a step back, take a pause and say, “Is this the right decision?” or “Why are we doing this?” Beyond that, make sure whoever you’re thinking of joining forces with has a philosophy that fits with yours. It doesn’t matter how much money is offered if, philosophically, you can’t come to terms.