From time to time employees also review one another, in a fashion. FMST pays staff a bonus when the group meets certain collections targets: 12 percent of revenue above the goal goes back to the employees. Occasionally, the physicians will ask employees to rate one another anonymously, and they use these ratings to determine how to divvy up some of the bonuses.

This system also struck me as dangerous. Doesn't it create division among staff? Nope.

"We're very team-oriented and very family-oriented," says Sanchez. "Our personal lives come first, and when something happens in your personal life, they understand."

Access to the physicians, along with the financial rewards that come with success, allows each employee to feel a sense of personal ownership in the practice. There is no rivalry between the front and back office because the employees are trained in and work in almost all aspects of the practice.

But FMST's physicians are most proud of the fact that they work hard to tell staff how much they appreciate them. Monetary demonstrations are always appreciated, but it seems that simple exhibitions of respect are just as important. The doctors presented LaTour with a Rolex in appreciation for her long service, but none of the staff mentioned this when I was there. Instead, they wanted to talk about how hard the doctors strive to obtain staff input before hiring anyone new, and how they make everyone feel equal.

"They do a great job of hiring the right people, and they always stress that we're a team, a group," LaTour says. "No one's above or below anyone."

More change coming

Soon, FMST will be expanding to a new, larger office, adding several new physicians, with the goal of tripling the size of the practice within a year.

On tap is a plan to offer local companies — Dallas/Fort Worth is becoming a kind of boomtown for Fortune 500 corporate offices — VIP service for executives. They'd also offer on-the-spot health services to employees, even transporting workers from their offices to the practice and back.

The physicians have been consulting locally based executives about these plans, and they are getting very encouraging feedback, Gothard says.

Still, the physicians aren't sure how the expansion will play out long-term. Will they be able to maintain their family atmosphere and flat organizational structure with so many new bodies? Will their new physician colleagues be as like-minded as Gothard, Crow, and Weyenberg are?

They're hopeful but uncertain. One thing they do know is, as Crow puts it, "We've innovated out the wazoo for a three-physician practice," and this new plan just seemed to be the next logical step.

But with things going so swimmingly, why not just sit on their hands and enjoy the fruits of their labors? That just wouldn't be them.

"The very approach that has made us successful so far is what's driving these changes," Gothard says.

Bob Keaveney is executive editor of Physicians Practice. He can be reached at bkeaveney@physicianspractice.com.

This article originally appeared in the November/December 2006 issue of Physicians Practice.