The lessons you learned in part 1 of this series introduced you to many of my medical practice eroding mistakes, not so different from hundreds of other physicians starting their practice, yet going well beyond good judgment that you might relate to in some way. For physicians who are never taught, never learned, never considered the importance of knowing how to effectively manage the business of their medical practice, which is basically all physicians who graduate from medical school, even today, it’s a matter of learning it all the hard way and having to suffer along the way more than you need to.
We normally consider ourselves as being quite intelligent, as being above average in common sense and judgment, and as being intellectually selective in understanding the academic steps necessary for a medical career to succeed. If we are in that elite group of academically enlightened individuals, then, why is it that you are easily convinced that the illustrious practice of medicine can easily be successful without a knowledge of managing a small business effectively and without implementing the proven elements applicable to all successful businesses?
Now, to dig much deeper into the reasons why all of us are caught in the web of medical tradition, miss out on the true business foundations, and near the end of our practice years are forced to realize we could have done much more with our medical practice. We could have been more business oriented, been a better manager, earned a lot more money, spent more time with our family, and used our intensive medical education to accomplish a much higher degree of personal accomplishment over those years. These regrets are ever present in the older docs, but too late to make amends. Not going to happen to you………right?
Medical practice business mistakes and solutions:
1. Believing that your position in medicine will miraculously launch you over any financial barriers you face (tradition):
Talk to any successful entrepreneur in business today and they will tell you that one of the best ways to rise to the top is using a leap frog financial strategy. When you open your first office, spend as little as possible, either by renting space in a reasonable location, or sharing office space with another physician until you have discretionary income enough to move, renovate, and go solo.
A common way to cut costs and save money is to join an existing medical practice with a formal cost sharing agreement on paper. Those physicians who start out as an HMO employee and later decide to go into private practice rarely save enough money to carry them into and through the first 6 months in a new practice. Face it! We have felt money deprivation for so many years by then that the first natural urge when you finally are earning some money is to spend it for “soul” satisfaction.
One of the reasons for holding off on buying a new car or house or signing a long term lease agreement for your office, at least for the first 3 years is related to your practice future. Presently, about 10 to 12% of doctors move their practice each year according to an AMA survey. They must have a good reason to do that. Right?
The two most common reasons for any physician to move their medical practice elsewhere are financial and financial. The first is a direct result of practice competition where a physician is unable to draw a sufficient flow of patients to financially sustain his or her practice business. The second is a little more subtle, goes unrecognized long before the crisis happens, and occurs at a time when sensibly it shouldn’t be happening. It’s a time when the chaos of your own unorganized and reactive management of your practice business reaches a point (usually 5 to 10 years into your practice) where your business instability can no longer be depended on for growth or financial independence of your practice. You should understand the underlying cause, but most physicians never see it.
You’ll notice that each of these financial disasters are those which could easily be resolved by knowing how to effectively run your practice business using business strategies that are employed in all successful businesses. You don’t have to move your practice…..just your mindset.
Often, this is also a time when you look back to the time when you were deciding where to start your medical practice. Where do I want to live for the next 30 or so years? Am I obligated to go back to my own home town because of family ties? Is it the climate that makes the most difference to you? Shall I go to a big city with lots of patients available?
If you are business literate, no matter what the emotional influences are, there are critical business related demographics that make a world of difference to your success or failure. For example, if you were an ObGyn physician looking for a place to practice, you should know the basic statistical data concerning your probability for practice success before you decide on the town or city or state. When you divide the number of OBG physicians practicing in the city into the population of the area and discover that the ratio is more than one ObGyn physician per 10,000 population you’ll probably not succeed there without a vicious struggle for patients.
Finding the ratio to be 1/20,000 population or more, would indicate you most likely will be able to start a practice there, build it rather fast, and hold a strong position for your practice business in the area.
Successful physicians are those who have checked their competition, visited the area where they want to start practice, matched the amenities to their family needs, researched the available consultants they will rely on, know the hospital facilities in detail, and have an exact mental picture of where they want to be 20 or 30 years in the future with their practice.
Medical students would be significantly far ahead to begin selecting an area to practice in long before they finish medical school. Most students are so busy learning they see no reason to do a little forward thinking, at least those who haven’t already made arrangements to join another physician already in practice, or selected a non-patient related field like research. Young doctors often just move into an area they like and hope for the best–a mistake they often regret.
Preparation for medical practice involves much more than medical knowledge! A fantastic physician in a lousy practice, or practice area, will result in disappointment carefully rationalized to the point of, “It’s good enough.” Is it?
2. Believing that your medical practice business will be successful enough simply by using your own mental accumulation of business experiences you’ve read and heard about:
Businesses fail when the business owner fails in one or more of the three requirements for having employees: Leadership, Management, Supervision.
If you insist on having employees, it shackles you with responsibility. There are things you simply have to do almost continuously to keep them from stealing you blind, force them to work to your specifications, and reward those who do—firing those who don’t.
The employer and employee relationship is inherently adversarial. Your personal agenda for the business interferes directly with their agenda. When you impose your agenda, you disrupt theirs.
Facts and reality about your business:
• They do not own your business. You do.
• Your business is your career and life and your life is your business.
• Employee agendas are saturated with unavoidable resentment that arises from disparities in wealth and power (that’s you).
• Employees are not your friends.
• Employees are not your family.
• You are not there to make your employees happy. They forget you are there to pay them for work, and to generate profits.
• Every single employee, irrespective of how much you pay them, how well you treat them, or how valuable to the practice they are, will leave your business sometime and will need to be replaced. It’s necessary at least twice a day to whack yourself beside the head to remind yourself about the true reality of running a business, that is, if you care anything about having a highly greased profitable business machine that you control. If you are considered to be a pain in the ass, that’s perfect.
When someone asks you what kind of employee you want, tell them a “profitable employee.” The only credible reason to have an employee is for profit. Don’t pile up a group of employees around you for irrational reasons. Business requires an ROI from each employee. Your job as CEO and owner is to maximum company income and business value.
Keep in mind it’s not your responsibility to provide Jane with a job, nor is it your responsibility to pay her enough to support herself or her family, or out of work husband who can’t find a job. It’s Jane’s responsibility to make herself such a valuable employee you can’t run your business without her. It’s her job, if not satisfied, to find a better paying job.
Job duties and responsibilities must be clearly communicated, repeated often, and taught. That’s your management job. Office managers don’t have the future view you have for the direction and goals you have for your business, nor what you envision as needed for what each employee must do to help you complete your mission. If you told your office manager all those details, do you think the manager would remember them all, or even be capable enough to take your place in this process?
Make an extreme effort to:
1. Replace any employee who doesn’t pull their load daily.
2. Avoid hiring older experienced people who will constantly be doing things they have learned—not what you want done.
3. Avoid being too friendly with employees because they will automatically manipulate you as a result.
4. Avoid automatic bonuses and rewards for certain jobs, holidays, birthdays, because they will then always expect them in the future.
5. Reward those who go well beyond what is expected of them, but only do it as a surprise to them.
6. Hire employees slowly—and fire them fast.
Studies have shown that the average firing occurs about 6 to 18 months after the business owner knew that the employee was consistently performing poorly, was routinely non-compliant, and was poisoning the rest of the staff.
Should you decide to be the kind old gentleman doctor who is loved and admired by his office staff because you are forgiving, benevolent, and leave them alone, then you should understand that the practice profits lost in doing so compromises your lifestyle, your maximum practice potential, your family needs, and your ability to have the income necessary to learn new skills, upgrade your medical knowledge, and improve your value to your patients. And that, my friend, is a no B.S. life principle that eventually will track you down and destroy your dream.