John Forrest, MD
The words “north” and “south” may conjure up images of the Civil War that divided, and then eventually reunited, the country. For Urologic Specialists of Oklahoma (USO) in Tulsa, the merging of north and south was free of such conflict and turmoil, yet still rooted in long-held personal ties and shared history.
USO co-founders John Forrest, MD, and Robert Bruce, MD, have known each other since the fourth grade. They both attended medical school at the University of Oklahoma and, after some time away from home, ultimately joined two different, well-established practices in north and south Tulsa
“Over time, we came up with the idea to merge our two large practices into one larger group,” Forrest explained. “It’s always been my feeling that with the changes in medicine, practicing in a larger, highly structured group was the wave of the future. It allows you certain positions in the marketplace in terms of how you practice medicine, how you respond to payers, and how you manage regulatory issues. We believed that being a large group would make us more agile to respond to changes in healthcare while providing a high level of expertise and service.”
The advantages of this model, Forrest explained, include shared, structured decision making; the ability to offer an array of ancillary services on site; and timely access to the latest healthcare management practices, such as electronic medical records.
USO formed in 1996 with nine doctors on the north side of town and four on the south side, housed in multiple locations, said Steve Dobbs, the practice’s CEO. In 2004, the 52,000-square-foot main campus was built, bringing the majority of the physicians and staff under one roof (the practice also maintains a small satellite office in another part of Tulsa). USO now has 20 physicians and will be welcoming two more later this year. Its areas of specialty include general urology, urologic oncology, pediatric oncology, renal transplantation, and a division devoted solely to female pelvic medicine.
Forrest and Dobbs spoke with Urologists in Cancer Care
about how the practice came together, how it maintains its union, and why outreach is a major part of its expansion plan.
The Ties That Bind
Beyond Forrest and Bruce’s long-term friendship, USO has many connections that give the practice its united front. But getting to the point of cohesion did require some adjustment.
Dobbs joined USO in 2011 and checked in with some of the veterans of the practice to learn more about the challenges it faced when first merging. Not surprisingly, one of the main issues was integrating the different cultures of two independent practices that had been around since the 1960s.
The practice managers looked to one of the driving principles of real estate to circumvent any culture clash: location, location, location.
“When they designed [the current] building, they strategically put one doctor from the north side and one doctor from the south side next to each other in a pod,” Dobbs said. “That way, people would ‘click’ together. In fact, even now, in every one of our pods, there are physicians who came from the south side practice and doctors who came from the north side. Of course, after all these years, north and south is a non-issue, but it was a smart way to get everyone to start working together as a group.”
In fact, USO physician-partners have taken that “all for one” philosophy even further with their salary structure. “We have a pooled income model,” Forrest said. “Basically, all of the full partners make the same amount of money. It’s not driven by patient volume, compensation formulas, or relative value units. We all subspecialize, but ultimately, our contributions are equal, so our income model reflects that.”
The shared income model is “all about doing the best we can for the patient,” Dobbs echoed. “If one of our physicians sees a patient, and determines that person would be better served by one of his partners, then that patient is referred. I see it happen every day.”
In addition to its central location and an egalitarian income model, the practice boasts other connections: Physicians David Confer, MD and Stephen Confer, MD are father and son, while physicians Oren Miller, MD and Curt Powell, MD served in the military together.