This article appears in the Fall 2019 issue of the
PE GI Journal
Creating success with attentive care and a dynamic management style.
Founding partner Dr. John Spivey left a multispecialty practice to begin Gastroenterology Associates of Fredericksburg (GAF) in 1990. With an unusually attentive style of patient care, the new practice soon outgrew its original 700-square-foot rental unit with three staffers to its current 20,000-square-foot location with eight physicians, five midlevel providers and numerous staff. They are now the largest practice in Fredericksburg, Virginia. GAF entered into a partnership with Physicians Endoscopy (PE) in 2018. PE Senior Vice President Carol Stopa spoke with three of the key players in the group: Chet Pai, DO, Managing Partner; Frank DeTrane, MD, Senior Partner; and Cheryl Leite, Practice Administrator, to learn how they have been able to maintain and grow a thriving GI practice.
Carol Stopa (CS): How would you define your leadership style?
Dr. Chet Pai (CP): I believe in adaptive leadership. I want people to have a similar vision for the practice and similar goals—staff, partners and board members—to make the work environment better.
Dr. Frank DeTrane (FD): Historically, I always strived to have a positive outlook and be very inclusive of all of the partners and associates, promoting mutual respect and appreciation for what each individual had to contribute to the success of the practice. GAF still has weekly physician meetings to promote open communication and to try to solve problems before they fester. It is also very important to remain focused and see every challenge as a potential opportunity to improve the quality of care and access for our patients. I would not hesitate to seek professional guidance, either locally or at national meetings, for the more complicated issues such as developing ancillary services.
Cheryl Leite (CL): A key element to my leadership style and what I think makes us successful is communication. I know it sounds a little cliché, but effective communication skills are essential to any leadership role. Over the years of my career, working with different providers, I’ve learned that people have different ways of delivering and receiving messages. Being the person who makes sure important messages are delivered and received is a key part of my role.
In addition to managing communication with and between the providers, it is important to keep the staff informed about what is going on, so I send out regular updates to the team. They appreciate that someone is cluing them in as to what is going on with the practice. I would also say I’m extremely collaborative. Staff on every level have great insights and good opinions, so I solicit input from people and ask them, “What do you see? What do you think we should be doing differently?” Our culture supports this. People are very respectful of your questions or suggestions, even if they don’t agree.
CS: What challenges have you successfully overcome when it comes to ongoing growth? Have you faced hurdles in staffing, equipment, facilities or management?
CP: We are working on all of those challenges. In terms of staff, finding the right providers is one big challenge. We are very selective about who will join our practice; we are trying to find the right partners and associates who have the same vision for the practice.
It’s not hard to attract people—but attracting the right person is hard. Each has to go through our vetting process, which involves all board members. We start with a phone call from one of the senior members of the practice to see if we should invite them for an interview. If that goes well, we invite them to visit the practice, along with their significant other. We don’t present an offer until everyone is comfortable. It’s a rather drawn-out engagement!
FD: Over the last 25 years, GAF has successfully overcome many challenges. We outgrew our office space twice, and in 2008 made a major investment in our future by building and owning our current 20,000-square-foot digestive center, which houses our two-room AAAHC-certified office endoscopy center and 21 exam rooms, allowing the physicians to be more efficient and productive. Our staff has grown exponentially as well, so we successfully recruited Cheryl in 2015 as our Practice Administrator. With her vast experience, she was able to restructure our outdated management system and assumed many of the responsibilities that the managing partner did not have time to address while working clinically full-time. Subsequently, we now rotate the managing partner position to interested partners to provide new energy and different perspectives to the future growth of GAF.
CL: Staff recruitment and retention is a challenge for our group, as with many practices. Most resumes I receive are from people who change jobs roughly every two years. Finding the right candidate who is the right fit for the practice but who is also prepared to commit for years to come is very difficult. I think we offer a very good, supportive, collegial work environment and competitive compensation and benefits. When recruiting, we really try to focus on fit and not just rush to fill a position with the first seemingly qualified candidate.
CS: As managing partner, what is your vision for the practice over the next several years?
CP: As a provider, I recently did my MBA at George Washington University, and I focused on healthcare in the U.S., and how to curtail the extraordinary costs. Traditionally, we have looked at healthcare through three prisms, one each belonging to the payer, the hospital and the provider. There has always been a struggle between hospital and payer, the provider and the payer, and so forth. I’m hoping we can all work together to create a system that could decrease costs while providing excellent service at the same time.
CS: What do you feel is important as you look to the immediate future?
CP: Internally, I want the staff to better themselves. The board of trustees has created an educational trust fund for any staff member who wants to further themselves in the practice without having to pay that money back. Of course, the person must be in good standing with the practice. Our external goal is to grow into the surrounding areas like Stafford, Culpepper and King George while making sure our quality is still No. 1. We’ve talked about having satellite offices and ambulatory surgery centers (ASCs) in different regions of Virginia.
CL: The practice has been very entrepreneurial and takes intelligent risks, and I think that positions us for long-term success. We have added ancillary services and anesthesia, for example. When you read articles that say, “private practice is a thing of the past,” and “you can’t survive on your own”—I don’t believe that’s true. If you make smart decisions and do what you do well, you can survive in private practice, especially if you enter strategic partnerships.
FD: To date, GAF has accomplished all of our growth within a single facility, which is on the campus of Mary Washington Hospital. This allows us to be very efficient in providing hospital coverage as well as performing office procedures. As we continue to grow, we will need to explore the possibility of and challenges to expanding into the surrounding community.
It is important to keep up to date with the latest developments in GI and give patients the service they are looking for. I now use a scribe to help document office visits in the EMR so I can focus on listening to the patient’s concerns and maintaining eye contact to reassure the patient. If the patient needs a timely procedure and our schedules are full, we give the patient the option to get it done as soon as possible with the first available provider. GAF has worked hard to achieve this level of service for the community of Fredericksburg, which allows patients to feel comfortable getting their care locally and only being referred to tertiary hospitals on rare occasions.
CP: We are a very dynamic practice. Our practice has younger physicians; most are in their 30s and 40s. Lifestyle is a priority for the providers—we don’t mandate a specific schedule for them. We can accommodate someone who needs a part-time position, either temporarily or permanently, or someone who prefers to work three, four or all five days per week. We want to make sure that our doctors don’t get burned out so they can provide the best patient care.
CS: What is the secret sauce to the practice’s success in attracting new physicians and providers?
CL: One of our barriers to recruitment is geography. Many physicians want to be closer to D.C. or another big city, so attracting great physicians to Fredericksburg can be difficult. But once we engage with a candidate, I think they enjoy the collegiality and humor that becomes evident during the interview process. Plus, our stability and success are draws, as is our size. With eight physicians and strong midlevel provider support, we are large enough that call is not overly burdensome, and we are small enough that we all see one another every day.
The fact that we offer a pretty short track to partnership has also been a strong selling point to most of the physicians who have joined our group in the past several years. The latest physicians to make partner were able to do so within a year of coming on board. And unlike some other practices, the requirements for partner eligibility are very transparent and don’t change once you are on the track. This practice is the most cohesive group of physicians I’ve ever worked with—they are cordial, collegial and respectful.
FD: Dr. Spivey set the culture of having a “can-do” attitude from an early stage, so we always try to look for solutions instead of just bringing up problems. We have heard of other practices that have a tier system, where associates aren’t allowed to be in meetings with the partners. I think that having mutual respect, positive attitude and professionalism, where you are trying to be inclusive and provide free expression of ideas, is essential.