ROBYN JACKSON

Hiring and firing employees. Work and patient flow problems. Creating a team spirit among employees. Payroll. Scheduling. Expanding. Monitoring expenditures and income. Developing a risk management plan.

They are all aspects physicians must deal with in their practices on a daily basis, but although doctors receive plenty of training so they can save lives, most receive precious little education on how to run a small business, which is what a practice really is.

"I went to school at the University of Missouri in Columbia and don't remember a single class oriented around the business of running a practice," said John Beaman, MD, who has owned a family practice clinic in Richton for 25 years.

"In fairness," Beaman said, "medical practice varies so widely from one situation and location to another and the practice of medicine has evolved so drastically since my training, it would
have been near impossible for the school to prepare me for this."

Beaman said classes in business and practice management would have been much more useful to him than some classes like "death and dying," which he said gave him no useful information at all.

He thinks business management classes should be available for doctors like him who envision running their own practices, but he said it probably would not apply to those who will become employees rather than managers who never have to worry about the business side of medicine.

Many doctors realize that they know nothing about business and will hire a manager to run the day to day operations of their practices, said Greg Butler, director of the Small Business Development Center at Jones County Junior College in Ellisville.

"I have had quite a few office managers that I've worked with," Butler said. The JCJC Small Business Development Center offers a workshop each month to teach individuals how to start and run a small business. Butler said he also does individual counseling to help small business owners improve their knowledge and management skills, or to help would-be entrepreneurs start a business.

"We do most of our work with businesses one on one," Butler said.

He recommends that doctors and medical office managers read "The E-Myth Physician: Why Most Medical Practices Don't Work and What To Do About It," by Michael E. Gerber ($13.95,
Collins Business).

Gerber, author of a series of "E-Myth" books, runs the E-Myth Academy, which is well-known in the entrepreneurial world for its business insight and guidance. In "The E-Myth Physician," he offers insights into topics such as streamlining systems, effective management practices, healthy patient relations and managing cash flow, all to help the physician get free of the daily grind of
running a business so they can practice medicine.

"His contention is that doctors create themselves a job, they don't create a business," Butler said. "Treat your patients like customers, realize that their time is valuable, too. That's the biggest thing I suggest to doctors. They don't teach you any of that at medical school."

When Douglas Rouse and Richard Conn opened their orthopedic medicine practice in Conn's father, Francis Conn's, old office in Hattiesburg, they soon realized they were in over their well-educated heads when it came to running the practice.

"We knew how to hire people, we didn't know how to fire them," Conn said. "If Doug and I knew how to look people in the eye and say 'you're gone,' we wouldn't have had to hire an office manager."

Rouse and Conn approached the growth of their practice in a business-like way, even drawing up a 10-year plan that included construction of what became Southern Bone and Joint Specialists PA. Their new facility, which includes a rehabilitation facility and outpatient surgical center, opened in 2000. They employ 11 surgeons and four anesthesiologists, with more coming in 2009, in addition to 140 office staff. They also have clinics in Columbia and Poplarville.

"There's nothing in medical school that teaches you how to do this," Conn said.

Beaman said the most difficult thing about running a small practice is finding and keeping competent staff members. He has one full-time and nine part-time employees. The second most difficult thing is dealing with the vagaries of insurance companies.

"A solo medical practice like mine is a relatively simple business to run. I handle all the management issues myself and probably spend two to three hours a week in this role," he said. "Learning practice management is an on-the-job affair. I tried reading the appropriate magazines but never found them very useful. There has been a lot of trial and error but I think we have now made and eliminated most of the errors."

Butler said if doctors treated their patients like customers, their practices would benefit.

"There are even doctors who are following 'The E-Myth' who promise they'll see you on time or it's free," he said. "If you had a doctor who practiced that, the practice would go through the roof."