British economist John Maynard Keynes, one of the most influential economists of the twentieth century, predicted in his 1930 essay, "Economic Possibilities for Our Grandchildren," that the biggest problem facing future generations would be what to do with all their leisure time. For most people, and in particular physicians, this prediction has certainly not become reality. Amidst the stirring controversy over healthcare reform, physicians are working harder than ever in the face of declining reimbursements.

 

The idea of physicians as businesspeople has a long and complicated history. Cultural norms over the centuries have influenced how society views doctors and their relationship with money. Our culture has swung from the physician as a fee-for-service craftsman healer to a professional with a massive shift to the third-party payer system. In this paradigm, physicians were supposed to be only concerned about patient care and not money. The financial aspect of the relationship was supposed to be handled by the new intermediary in the physician patient relationship–the insurer. The recent advent of HMOs ironically brought monetary considerations back to the forefront again.

 

Physicians in medical practice today face a complex mix of financial, regulatory, operational, and clinical challenges. To deal with the stressors of earning a living in this field, I believe that physicians should embrace an entrepreneurial mindset to create the life and practice they desire. Therefore, I begin below summarizing habits of successful entrepreneurially minded physicians.

 

Unless you practice alone without staff, then you probably work with a team to provide patient care. This means by default that you are a leader, whether you care to be or not. You may be a great physician, but if you are a terrible leader, then your practice, and ultimately patient care, will suffer. Successful leaders can look in the mirror and be honest and candid about their strengths and weaknesses. We all have a tendency to deceive ourselves. Great leaders are self-aware and accentuate their strengths and mitigate their weaknesses by hiring quality people. Practical steps for becoming a better leader include taking simple diagnostic personality tests like DISC or Myers Briggs® to better understand your strengths, weaknesses, and management style. Leadership skills can and should be developed. Leadership material from experts like John Maxwell, Ken Blanchard, and Jim Collins are not just for business owners, they have relevant application in a medical practice. Remember, you are leading whether you acknowledge it or not, so why not be improving in this critical arena?

 

Bestselling author Jim Collins in Good to Great described this as getting the right people on the bus. While nobody wants to hire the wrong person, we all make this mistake on a routine basis. When you hire, train, and ultimately have to fire someone who is a wrong fit for your organization, the costs are huge. In fact, most people never really calculate the actual financial costs of hiring the wrong person. Those that do usually are much more prone to follow the wisdom of "hire slow, and fire fast." Most hiring takes place based on a phone interview and one or two brief in-person interview visits. Great businesses take their time and really try to get it right the first time. They take the time to document the skills and personality profile needed for the job. Pre-employment personality testing and similar tools can be effectively used to make sure there is a good fit with a prospective employee. The simple act of reference checking is also critical, but often overlooked. The bottom line is that even though everyone is ultimately replaceable, you don't want your staff to be a revolving door of employees. Your team will spend a lot more time with your customers (patients) than you will. Whether your team is full of "A" players or poor performers will have a direct impact on your bottom line. 

 

Medicine is all about data. Years of training have prepared you to gather, synthesize, and analyze data. This is a tremendous skill that should be employed in the operational elements of your practice as well. The old management adage "you can't change what you don't measure" applies in a physician practice as well. Great businesses measure their performance, evaluate it, and improve upon it. In a physician practice, potential items to measure include: percentage of no-shows, capacity analysis, referrals and sources, average patient cycle time/office wait, new patients, patient satisfaction, marketing activity results, revenue per patient, and collection percentages. I recommend that physicians utilize dashboards to provide the ability to quickly review the key items they are measuring. These should be graphically displayed, easily and quickly reviewable, and provide historic comparisons or context so you can trend spot. There is no point in gathering data that you don't analyze and act upon. It is important for all members of your team to have key measurements associated with their work and productivity. Every employee should know how to keep score on how they are doing in their job. Tracking stats isn't just helpful for analyzing batting averages or passes completed; it can radically change the performance of your medical practice as well.

 

In sum, knowing yourself and becoming a better leader, hiring top talent, and measuring performance are three critical habits to cultivate in a physician practice. Habits are not created overnight, but instead develop with purposefulness and discipline. In future columns, I will explore additional entrepreneurial habits of successful medical practices.