It’s been two years since I first started my new practice. I have successfully avoided driving my business into the ground because I am a dumb-ass doctor. Don’t get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict. No, I am talking about being a dumb-ass running the businessbecause I am a doctor.
We doctors are generally really bad at running businesses, and I am no exception. In my previous practice, I successfully delegated any authority I had as the senior partner so that I didn’t know what was going on in most of the practice.
The culmination of this was when I was greeted by a “Dear Rob” letter from my partners who wanted a divorce from me. It wasn’t a total shock that this happened, but it wasn’t fun. My mistake in this was to back off and try to “just be a doctor while others ran the business.” It’s my business, and I should have known what was happening. I didn’t, and it is now no longer my business.
This new business was built on the premise that I am a dumb-ass doctor when it comes to business. I consciously avoided making things too complicated. I wanted no copays for visits (and hence no need to collect money each visit). I wanted no long-term contracts (and hence no need to refund money if I or the patient was hit by a meteor or attacked by a yeti). The goal was to keep things as easy as possible, and this is a very good business policy.
Despite this, I’ve increasingly had to educate my gluteal muscles over the past two years. I am not allowed to abdicate my responsibility as a business owner any more. It’s hard, as I have never been one who likes to attend to the numbers after the decimal point or the fine print in the contracts. My ADD screams when these things come into my visual fields, hitting me with the uncontrollable urge to play “Candy Crush Saga” or watch “American Idol.” I want to turn my mind off whenever confronted with minutia. It’s taken a while to decondition this Pavlovian response. I am getting better at it.
The good news is that I actually want to get more organized and on top of the business. I am starting to enjoy spreadsheets, budgets, and even task managers. No, I’m not ready for my membership card for Pinheads International – I’m still not able to look at fine print without high doses of caffeine and antiemetics – but things are moving in the right direction.
So how does one avoid being a dumb-ass doctor? Here are my tips for doctors wishing to retrain their buttocks:
- Don’t ever forget that it is your business. No matter how much employees are invested in the business (and mine are as good as they get), nobody cares like you do and nobody pays the price you will pay if things fail.
- Don’t try to change overnight. I’ve learned these lessons over the past two years; they weren’t there in the beginning. I’ve had to go through the process of change, which has come out of my desire to do best for my patients and still make a reasonable income.
- Speaking of income, if you start a business like I did, don’t forget to pay yourself. It’s cool to get new gadgets or fancy task management programs (heh), but they don’t pay your mortgage or your kid’s tuition. There are plenty of ways that I want to grow the business, but that must wait until the cash-flow lets me do it.
- On the other hand, don’t skimp on things that will let you grow the business or improve service (which means you keep your patients). It’s OK to borrow money if it helps bring in new patients and/or retain your present patients.
- Hire staff that believe in your mission. I can’t stress this enough for this kind of practice; my nurses are very dedicated to my practice and bend over backwards for my patients because they relish the chance to take care of people.
All this being said, here are some dumb-ass things that I avoided:
- I kept it simple. The business of medicine is a morass of rules, codes, and disclaimers. It’s way too much for docs to deal with. I don’t charge copays. I don’t expect people to pay more than 1 month at a time. I don’t file insurance. I don’t nickel and dime people for charges if I don’t need to.
- I didn’t plan too much. I got all bent out of shape in the first few months we were open, as I wasn’t doing everything I imagined doing. I realized (after being politely called a dumb-ass by a friend) that it would take time to figure out how to do all of the stuff I hoped to do. We’ve prioritized what is most important to our patients: access, and have been working to improve the process and quality since then.
- We didn’t grow too fast. This partly comes out of the fact that I was a dumb-ass, deciding to build my own EMR system, and was hence too busy doing that junk to focus on growth. To be fair, the system is the central way we are working to improve our care quality, so it’s not all bad. But growing too fast will decrease the quality of care patients are getting.
- I didn’t pay a whole lot in advance for a consultant to give me a business plan I’d just abandon. This business is so new, it would’ve taken a person with a crystal ball to view into the future and anticipate what would happen. I am very glad I didn’t wast the money.
- I’ve enjoyed the chance to do what I want. We have fun in our office. We laugh at ourselves and each other. Despite all of the stress of starting a business, it all seems worth it when I think about what I left behind.
- I accepted and embraced the reality of my dumb-assness. Doing so has lowered my expectations and made me more open to learning and listening to others. Those aren’t easy things for us docs to do (I often wonder if “MD” stands for “Major Dumb-Ass”).
That last one is probably the most important one to learn. I have to learn how to learn and that I need to learn.
Ironically, I am grateful for my old mistakes that drove me from my old practice. Without those mistakes I’d still be on the hamster wheel of codes and data, making my patients angry and giving them lousy care. I am now nearly up to 600 patients, have 2 nurses, and am proud of what we do. I am also excited about our future, which is something most docs (and patients) cannot say.
Dr. Rob Lamberts is a primary care physician in Georgia.
Congrats on surviving two years. Now, to supplement your income (perhaps for retirement purposes), might I suggest you stop giving away your wisdom and go for the infomercial approach and seminar plan so you can teach others. You remember residency training, “each one do one teach one.”
As a health care economist I see way too many physicians (employed) who hate what they are doing and need to escape corporate medicine to return to professional small business medicine that is patient focused. Its a model we might want to encourage.
Thanks. In reality, I have considered doing some sort of consultation to help others do this kind of thing. The problem is, I went this way so I could give attention to my patients, and more involvement in that, as lucrative as it may be, would potentially take me away from my patients. My hope is that, if done properly, I will not only have a better life and happier patients than my non-DPC colleagues, but will also out-earn them. Things are looking up, to be certain.
Congrats on your two year new practice anniversary. I can see why running your own practice is working for you. (It’s working for me, too, although my practice is very small, consultative, and part-time. I’m not building a long-term practice the way you are.)
But curious to know what kind of business/practice arrangement you envision for most primary care doctors in 10 years. Small (1-2 docs) physician run practices like yours? Medium to large physician led practices? Bigger vertically integrated practices? Some of all the above?
Medicine involves so much continous learning and efforts with patients that it’s a bit crazy to expect docs to learn to run a business too. But when doctors don’t run businesses, the businesses run them, and so far that’s not been so good either.
If the business of medicine isn’t as crazy complicated as it has been (and is easy enough that even I can do it), then it’s more reasonable for docs to take back a lot of the control of the business. I do think bigger groups like Qliant and MedLion are one model, where other smaller practices like mine are another. I can see alliances and networks of DPC docs working together as well. In truth, I don’t know what the big picture will look like it, but this practice model does three important things:
1. Makes life better for the doctors (and nurses)
2. Makes care better for patients
3. Saves money.
If this can be grown to where widespread adoption won’t kill the system (creating a shortage of PCP’s), then I think this will shape itself.
Excellent. I think it is a terrible trend that so many docs have given up control of their businesses…and thus the profession has lost the power the control its’ fate…..as govt and insurance and administrator bureaucrats change everything…..and most docs today are just employees.
You are an inspiration to me. I can relate to so many things you have mentioned although I am on the other side of the world.
I am trying my best to not be a “dumb-ass” doctor.
Several readers wrote us to note that “Dumb-Ass” doctor should be hyphenated in our headline. The error has been corrected. THCB regrets the error.
You speak the truth Rob.
As a collective group, we are dumb asses …
Your quest for personal enlightenment is an inspiration to us all