| The full story behind this doctor's practice downfall | | | | including hotel, food, travel and the course. |
| isn't unique, nothing to excite the non-fiction writers | | | | A couple weeks later I found it necessary to |
| unless it can be defined as a model of what not to | | | | terminate my front desk employee. Within two days |
| do in medical office management. Having absolutely | | | | the back office lady quit with no notice. The back |
| no background knowledge, college courses, or | | | | office lady knew why I had fired the front office |
| medical school training about business management, | | | | lady and what she had been doing unethically. I had |
| office management, or marketing at the time I | | | | no idea they were that closely attached, bound by |
| started my private medical practice, I never thought, | | | | their own "employee honor system," or created a |
| let alone even considered this knowledge would be | | | | perfect window to quit that the other situation |
| of much value to me. Unfortunately, even today, | | | | openedfor her. |
| most physicians continue to consider small business | | | | Of course, the back office employee, after spending |
| office knowledge and systems like a popcorn | | | | over a thousand dollars on her training, being nice |
| movie-entertaining, but nothing of practical value. | | | | enough to pay for her husband's vacation with her, |
| Over the next 20 years in private practice I gradually | | | | and for 7 years in my office learning medical office |
| came to recognize the covert signs of a doomed | | | | functions never mentioned she was thinking of |
| medical practice. I am ashamed to admit to anyone I | | | | quitting, yet abused my generosity without a second |
| didn't know how to handle the quicksand of disabling | | | | thought. She refused to explain why she was quitting |
| factors which surrounded me in my practice. The | | | | but I suspect she had already lined up a job in |
| specific events, which spelled out and magnified my | | | | another doctor's office to do his ultrasounds for |
| business ignorance, were: | | | | higher pay. |
| Violating common sense budgeting for the | | | | Can you stomach the results when you let your |
| business. By the third year in private practice I had an | | | | medical office run itself? My blunders should be a |
| opportunity to purchase a small medical building with 5 | | | | resounding wake-up call for you to start marching to |
| medical office suites with a very small down payment | | | | a different drummer. |
| and paid the mortgage with the rental paid by the | | | | Blunder #1. I wanted everyone to like me, especially |
| physician tenants. Seemed like the right decision. | | | | my employees because I have always been a very |
| But, to add wood to the fire, my next decision was | | | | generous person, easy to like and work with, made |
| to spend about $70K to renovate and upgrade my | | | | few demands on my employees. My very first office |
| office in that building and figured I'd pay for that | | | | employee was an older lady that I shared with two |
| over the next 15 years, never considering I might | | | | other consultant physicians from the next town. She |
| need to move elsewhere sometime, or struggle with | | | | was very likable, friendly with everyone instantly, and |
| the attrition of my practice, or my tenants might | | | | could charm any hostile patient right out of their |
| move out, or economics of medical practice might | | | | pull-ups. Her experience in medical office work |
| change for the worse (as they did in 1976). | | | | spanned many years. Her choice of working only part |
| Going into heavy debt just never worried me----big | | | | time enabled me to hire a full time office manager. |
| mistake! Certainly relying on my overconfidence and | | | | She was happy doing my office billing and collections |
| professional status, how could I lose no matter what | | | | part time. |
| came along. Could sound business knowledge have | | | | Twenty years later she was still there doing the |
| prevented this-I'd like to think so. My CPA sure didn't | | | | same job. I could never let her go or replace her in |
| help me. My corporate attorney didn't either. None of | | | | spite of the poor job she was doing because she |
| my family had any business expertise to offer me. | | | | was my greatest promoter, seemed to know |
| My vision of my life in medical practice | | | | everyone in the medical community, had more |
| disappeared. I'll never know why but one day I sat | | | | connections with other medical offices than anyone |
| down about 5 years into my practice to try and | | | | else, and bragged to almost everyone how great a |
| figure out how my practice was doing and get an | | | | doctor I was and how wonderful I treated my |
| idea of whether it was going anywhere. I'd never | | | | patients. My office income wasn't the best and the |
| even thought of keeping statistics such as the | | | | billing processes often came up lacking, but new |
| number of new patients each month, or on anything | | | | patients kept coming in with her name in hand. |
| else related to my practice. So, I relied on the | | | | It's what Michael Gerber, author, consultant and |
| monthly financial statements from my CPA, which I | | | | business advisor to hundreds of physicians calls a |
| really didn't know how to read or make sense of in | | | | "physician employee" which he describes as a doctor |
| any effective manner, as a means of formulating | | | | who settles for a mediocre medical practice and |
| critical decisions about my practice business-not that | | | | being "good enough." |
| you have ever been there. That methodology was | | | | Blunder #2: It was one of those examples of how a |
| and is like rearranging the chairs on the deck of the | | | | employee reward system over time became |
| Titanic. | | | | "expected" rewards on a regular basis without any |
| I read the numbers, calculated amounts, categorized | | | | increase in their work efforts, efficiency, and |
| the results, and came up with what Winston Churchill | | | | productivity. My fault. You see, my thinking was, and |
| called, "A riddle wrapped in a mystery inside and | | | | is commonly what many doctors still think, rewards = |
| enigma." Evidently, I had boarded the clue train. One | | | | results. Absolutely, not true! Rewards don't increase |
| thing was abundantly clear. It would never be possible | | | | motivation, it comes from inside. |
| for me to make enough money in my practice of | | | | An example of the extremes I went to were a bit |
| OB-Gyn to pay for my three kid's college education, | | | | unusual and overly generous at times. My excitement |
| nor ever be able to fund a retirement plan to any | | | | about how well my medical practice was increasing, |
| sufficient level. | | | | mixed with some social jujitsu, and a neck wrestling |
| Psychologists, spiritual leaders, self-improvement | | | | desire to treat all my employees, led me into |
| experts, and mind benders can very well look at my | | | | objective amnesia concerning the event. After |
| behavioral pattern as a true example of collective | | | | appropriate arrangements were made, office closed |
| insanity, intellectual immaturity, or need for a psychic | | | | for the day, we piled into a commuter flight from |
| hotline. They're probably right, within certain bounds | | | | San Francisco to San Diego for a joyous day of |
| and without knowing my personal attributes. But, | | | | sport and entertainment. We toured "old town," |
| when it comes to comparing myself to other | | | | made it through Sea World OK, spent the rest of the |
| physicians, then and now, I wonder how many of | | | | time shopping on the waterfront, and had a great |
| them are a mediocre jockey on a hell of a horse. | | | | meal at a fine restaurant before flying back to the |
| My thought was, "I've gone through the entire | | | | bay area. Naturally, it didn't cost the employees a |
| educational gauntlet, sacrificed years of my life to my | | | | nickel. |
| ambition, invested thousands of imputed dollars in the | | | | The day became the topic of conversation in the |
| process, and now I see that what I have to show | | | | office for the next few days, the thank you's were |
| for it-stinks (a replacement word for the ones I was | | | | plentiful, and the office work never improved. |
| thinking)." | | | | Sometimes, when you show the caveman "fire," it |
| How could I resolve the dilemma (or how would | | | | triggers an increased responsibility and loyalty---but |
| you)? | | | | usually not. |
| --Start a new career that offered more financial gain? | | | | Another similar such inspiring attempt at business |
| --Start a sideline business to supplement my income? | | | | smarts a couple years later resulted in a good face |
| --Become a paid employee of a managed care | | | | licking, but not much more. In another of my eureka |
| group? | | | | moments I arranged for a special dinner meeting for |
| --Move my practice to another area? | | | | all my employees and their spouses at one of the |
| --Work longer and harder daily till I burn-out? | | | | most expensive elegant restaurants in town. Near the |
| --Focus my practice on high income patient | | | | end of the dinner I presented a unique shiny 14 inch |
| procedures? | | | | wooden wall plack to each employee which included a |
| --Retrain as a plastic surgeon or anesthesiologist? | | | | gold plate engraved with their own name and below |
| You will never convince me that you haven't run | | | | the name was a 4 to 6 line personal description I |
| these thoughts through your mind from time to time. | | | | wrote about their expertise and value to my office |
| Although you can put yourself in my position and | | | | team. It impressed the employee's significant other, |
| understand the unending analyzing and agonizing one | | | | was a terrific way to praise my crew, and was |
| must go through, perhaps you have already; a choice | | | | sincerely appreciated. My mistake was not taking |
| has to be made. The choice of taking on business | | | | advantage of the follow-up and demand more from |
| education and marketing courses should have been | | | | the employees. |
| added to the list, been a better choice than most of | | | | Blunder #3: This has to do with my lousy hiring and |
| the others, and, unfortunately, remained unrecognized | | | | firing incompetence. Of course, it was the first time |
| as a business tool among most physicians-even | | | | in my life I had to do such things, and had absolutely |
| today. | | | | no understanding of the process, interview process, |
| Because most of the choices involved extra costs, | | | | format for extracting information from the candidate, |
| some time away from practice, and my own rigid | | | | or qualities needed for working in a medical office. |
| thoughts about what I mentally and physically could | | | | Experts tell us to "hire slow" and "fire fast." Thirty |
| and couldn't tolerate, I decided to do real estate | | | | years later I finally heard that. |
| investing as a sideline business. It seems to be such | | | | I had invested a considerable amount of money in an |
| an outrageous synthetic experience when I look at it | | | | office computer system in the early 1980's knowing |
| now. Here I couldn't even think of a practical way to | | | | that it would increase office efficiency. None of my |
| inject my practice with growth hormone, and then | | | | employees were computer literate business wise and |
| went ahead and involved myself in another business I | | | | had to be trained for the process. Shortly after I |
| didn't know how to run. It didn't work out as I had | | | | hired a member of the computer company training |
| planned. I lost everything except my practice-back to | | | | team who lived close by and seemed well qualified |
| page one. Would all of this have happened if I had | | | | for medical office work. I didn't really interview her |
| been educated in the basics and principles for running | | | | (bad decision), just asked her if she would like to |
| a small business (involving marketing as an integral | | | | work for me full time. Her chuckling boisterous |
| part of that) as well-maybe. | | | | personality along with being mentally sharp was a |
| 1. My complete incompetence in managing employees. | | | | cover for her overly ambitious agenda. |
| Although most physicians are able to eventually, after | | | | Everyone of my employees were required to wear |
| a Sabbath journey to reach holy ground, reluctantly | | | | an office uniform, or white coat and never |
| accept the "spontaneous" office management | | | | complained. This lady, once hired, flat refused to |
| system that has emerged among his or her | | | | wear a uniform or a white coat. It angered me, but |
| employees without any effort on their own part, it's | | | | rationalized (another mistake) my acceptance of her |
| a permanent source of practice destruction. | | | | choice not to comply because she knew computers |
| I know because I used that system, never | | | | inside and out and would be an asset to the office. |
| understood how to make it any better, and many | | | | Over and over again she continued to be a |
| times sat behind my desk after everyone had gone | | | | problem---and I continued to rationalize each time. |
| home and had what Joel Osteen, the pastor, calls a | | | | She knew exactly how to manipulate me and do |
| "pity party" for myself. Did I really do that? | | | | exactly what she chose to do using her computer |
| But then, if you're the decision maker, I always | | | | expertise as leverage. After tolerating her antics for |
| remembered the saying, "If you're not ahead of the | | | | a few years, feeling all along I would never be able |
| threat, you're reacting to it." And, boy was I reacting | | | | to find a good replacement for her expertise, she |
| to it, especially when I found out certain things going | | | | had to be fired----and I mentally could not do that |
| on with my employees behind my back in my office | | | | procedure (what a wimp). My office manager fired |
| such as: | | | | her. The rest of the employees, were happy she |
| My receptionist secretly using the copy machine to | | | | was leaving, were well aware of her manipulation |
| print up her church bulletins for the congregation | | | | tactics she even used on them, and, remarkably, |
| weekly without my knowledge. She had been doing it | | | | chose to never once come to me and tell me all that |
| for almost a year before I found out. | | | | she had been doing that I never found out about. |
| 2. Example of my working "in" my business instead of | | | | The whole experience woke up my sixth sense for |
| "on" my business: My front desk employee assigned | | | | the first time, drove red hot spikes through my brain |
| to do all the left over filing, answering the phone, and | | | | to keep reminding me, raised the bar on employee |
| keeping the office open and running on Wednesday | | | | qualifications, established new rules of engagement |
| when I was not there, decided on her own to close | | | | with my employees, and became a permanent |
| up the office, put the phones on the answering | | | | example of the complexities of medical office |
| service, and have a free day off to do her personal | | | | hierarchy. |
| things for herself. The other employees knew it and | | | | Comment: |
| never told me. I made the discovery when I met up | | | | I am way too ashamed to tell you about the rest of |
| with her one Wednesday moving through the shops | | | | my business in-competencies. What is amazing to me |
| in the mall. Did I fire her? That's my next section of | | | | is the fact that most physicians suffer with some of |
| discussion below. | | | | these disabilities, know it, contend frequently with |
| 3. The importance of employee comradery didn't | | | | them----and never do anything about it---just like I did |
| mean to me any more than social interaction | | | | for so many years. Getting unstuck from this mindset |
| happening around the office until the truth slapped | | | | is not difficult once you know how to go about it. |
| me in the face. I decided to send my top notch back | | | | In the next newsletter I will discuss in detail each of |
| office lady to an Ultrasound training course about 90 | | | | my operational hiccups noted above and how you |
| miles away so she could do the OB ultrasounds as | | | | need to feed your mind with the right stuff, avoid |
| well as me. She was not able to tolerate being | | | | these perpetual hassles, and develop a mindset |
| without her husband for the 21/2 days and insisted | | | | appropriate for managing you office and small |
| he go along. I paid for everything for the venture | | | | business entity using the tools I tell you about. |