Feature

Ask psychologist Paul C. Schoenfeld, PhD, to describe the Everett Clinic, and he reels off a list of numbers that add up to a thriving multispecialty medical practice based in Everett, Wash.

Established in 1924, the clinic now has nine locations serving approximately 200,000 patients around Snohomish County. The clinic's 1,200 employees include 89 primary- care physicians and 95 specialists. The clinic needs all those employees to manage a caseload that comes to 1,900 patient visits each day and a whopping half-million visits each year.

For Schoenfeld, however, the most important number is this one: He is the only shareholder in the practice who isn't a physician.

Like a growing number of states, Washington has overturned a law that once kept nonphysicians from becoming shareholders in medical practices. Designed to prevent businesspeople from unduly influencing medical care, such laws are now giving way to the recognition that other licensed health-care providers can play a crucial role in medical practices.

Laws vary from state to state regarding whether and how psychologists are able to participate in multidisciplinary practices. But, when state laws permit, it can mean opportunities for psychologists, says Schoenfeld, who knows of no other psychologist in his state who has become a full partner in a medical practice.

"Voting me in as a shareholder was a very big thing for our group, because letting one nonphysician in could possibly open the door to other nonphysicians," says Schoenfeld, the director of the Center for Behavioral Health at the clinic's headquarters in Everett. "Voting me in was a way of saying that behavioral health is a really critical component of what the clinic does."

The clinic's commitment to behavioral health began in the early 1990s, when the clinic took on a group of 10,000 patients whose care was prepaid. Because the clinic had assumed the financial risk for these patients' behavioral health care, the shareholders decided that simply referring patients to local psychotherapists was no longer sufficient.

In 1993, the clinic hired Schoenfeld to develop a behavioral health department. Five years later, the state made it legal for nonphysicians to become partners in medical practices. By then, the behavioral health department had become an integral part of the clinic. Just how integral became clear when the physicians voted Schoenfeld in as the practice's sole nonphysician shareholder in 1999.

That decision puts Schoenfeld on an equal footing with his physician colleagues when it comes to running the practice. Now that he is a shareholder, he can vote on all clinic issues, serve on committees or even run for the clinic's board of directors. If the group ever decides to sell the practice, he and the other partners would reap a significant financial benefit as well.

Today Schoenfeld glories in the variety that working in a medical practice offers. He spends half his time supervising a behavioral health team consisting of three psychologists, four social workers, a nurse practitioner and several consulting psychiatrists.

The other half of his time is spent in patient care. On any given day, he might find himself working with a neurologist at the headache center the clinic started or running a support group for cancer patients. He might be teaching his physician colleagues how to manage stress or helping them tackle thorny management issues, such as personnel problems. He even conducts critical incident debriefings for staff after stressful events, such as the death of a patient.

Variety isn't the only reason he urges other psychologists to explore opportunities in multispecialty medical practices, however. For Schoenfeld, the opportunity to play a role in managing the clinic is key.

"Instead of having decisions about care made by administrators who may never have seen a patient in their whole lives, multispecialty medical groups are run by the practitioners who are providing the care," says Schoenfeld. "That enables us to provide a higher quality of care."



Rebecca A. Clay is a writer in Washington, D.C.