Medical Practice Business Ezine Newsletter      Jun. 2014

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Are you losing your private medical practice because you can’t earn enough to keep it open? If so, it’s because you have never had a formal business education! “They” taught you how to practice medicine, but not how to run a business profitably.

You can learn these simple business
lessons on this site!

Article #54 - June 2014   

 “The One Reason Plans, Goals, Careers,
and Maximum Success Rarely Are
Achieved for Physicians and Other
Healthcare Professionals”

(Part 1 of 2)

The lack of “due diligence” in regard to the pursuit
of one’s ultimate intentional destination in life eventually results in surrender of their
dreams to the unexpected circumstances
that opportunity presents. 

      For a large percentage of regular people who have a passion to do great things in their lives, their future becomes a series of personal and uninformed decisions based more on emotion than facts.
     The problem is that those decisions are
unaccompanied by a serious investigation into the
essential elements required for attainment of each step
in their progress towards their original desired
destination. Consequently, they arrive at a different destination than they expected.
     For example, w
hen you finally made a decision to become a doctor, did you research, visit, and interview
at the various college and university premedical
programs and curriculums that factually and predictably had a higher rate of acceptance of premed students into
medical schools?

     Or did you choose that college or university based on some other personal reasons unrelated to your chances
of getting into the medical school of your choice? Did
you even have a medical school choice?

     If you diligently did an investigation, you might have found that the medical school of your choice always made the selection of medical school applicants from certain premed programs and certain schools above all others. That would necessarily increase your chances of being selected to that choice medical school.
     Maybe you were so glad to get into any school premed program that you had not thoughts about any of those future decisions. In your last year of high school did you make any attempt to find a mentor who could have
helped you plan the most advantageous steps to take
that would have predictably guaranteed your
career path?

     Most high school students have no idea that they
would get great value from a mentor or career planner,
or how would you even find that mentor who knew the ropes about medical career planning? It would take something akin to due diligence.

     It’s likely that most premed students today are in a premed program at a college or university that they “heard” had a good premed program, and never actually checked it out to be sure.
     You already know that there exists huge competition among premed schools to attract premed students. Well, have you (or did you) ever consider how that might
affect your chances of being accepted to medical school later? Probably not.

     Think about this realistically. You are in a premed
group of 50 and you discover that the medical school you prefer to go to only accepts 2 students from your premed group. Another college’s premed group of 20 premeds
who are applying to your choice medical school for the same two spots. Which would offer you the best chance
of being accepted into your choice medical school?
     You would have given yourself a much better chance
of being accepted into your medical school choice. Oh
yes, there are other such things to consider like premed advisor recommendations, if there is another doctor in
your family, college grade average, among others. Who writes the recommendation is important, because medical schools know how reliable that person’s
recommendation is.
     However, most premed students have only one goal…just get into any medical school anywhere. You would benefit by the statistics about the number of premeds
from each premed college program that are never
accepted to medical school, even after reapplying several times. In my premed class, several were accepted to
dental school. In the long run they may have done far better than I did.

What about due diligence in selecting the medical specialty you are best fitted for?

     Now you’re in medical school and the elation and celebration of being in medical school makes you shift gears to the next goal. It’s probable that the old fashioned general practitioner and family doctor will be disappearing along with the demise of private medical practice in the near future.
     Internal medicine has already ransacked the primary care arena. I expect that all primary care doctors will be required to become Internal Medicine specialists in the near future. If all healthcare is in control of our government (Socialized Medicine) soon, as expected, then doctors will eventually be told what specialty to focus on and even geographically where to practice.

     But, at least for the next several years, most medical students will still have choices of type of practice and where to practice.

     Diligence comes into the picture at the beginning of medical school, and unfortunately, far earlier than you want to have to make any decisions about specialty,
where to do residency/internship, or where to practice.
The best opportunity you will ever have to change your mind about your prior intentions and desires is during
the first year of medical school.

     The problem here is that most medical students have very little idea where their talents, skills, and desires are best used, or even if they have some of those.
     As a general rule, most medical students require the first three years of medical school exposure to the
various kinds of medical practice to even begin to have enough reasonable judgment about where their talents
and interests should be invested.
     How do you discover what talents and skills you
already have? You may have already taken all the tests earlier that are supposed to point you in the right
direction. I will tell you that nothing will reveal the truth
to you other than direct experience doing elements of medical practice in medical school.
     Even that process may confuse you. Each specialty clinic you rotate through usually tells you clearly about what you can or can’t spend the rest of your life
practicing medicine in. So, you end up picking the top 5 ones that seem the most desirable and interesting, and then choose one to go after.
     I discovered that I could never tolerate sticking
needles into the scalp veins of babies while they
screamed, and while I imagined their mother holding a baseball bat standing behind me watching the procedure.

     Coming to those decisions is not easy for any student. No one has yet devised a system or method for making these choices.
     My personal experience in medical school (1958-62) has undoubtedly changed considerably like everything
else in medicine. But, I can’t ever remember any instructor, practitioner teaching us, or academic telling
me what they could see my talents or skills as being best fitted for. So I was on my own to make those choices. I chose OB-Gyn.

     I chose that specialty because my thinking at the time was...

  • If I didn’t like one of them, I’d quit it and do the
    one I liked the most and felt most comfortable
    confidence wise.
  • The specialty included both surgical and medical
    areas of medical practice and left me options for changing my focus of choice within the
    specialty later.
  • I discovered that in either side of the OBG specialty
    I would get immediate gratification with what I did
    and see the results there and then.
  • I realized that I would get more gratification with solving a surgical problem than with the long
    process of diagnosing the medical problem and
    then following and treating a patient's medical
    problem for years to come.
  • Within the specialty there were many more than
    usual numbers of potential subspecialties that I
    could later focus on if need be, or if my talents
    seemed more compatible with... such as gyn endocrinology, infertility, gyn oncology, and radical pelvic surgery.

     Consequently, later in my OBG medical career,
medical practice had changed radically altering
my original choices. It was something I had not
anticipated and should have.

It's not that I couldn't make changes in my practice,
but that the change would mean I'd have to shift my practice focus (like quitting OB and continuing with
Gyn) when it takes years to develop a Gyn only practice and earn enough to stay in practice. So I licked my
wounds and continued with both.

A few of these alternatives that I was confronted with and was forced to make radical changes in
my medical practice were...

         Laparoscopy was introduced in the USA (late 1970s) by Dr. Kurt Semm. The thought that one could do a large about of surgery without doing a laparotomy intrigued me both as a surgical
challenge and for patient safety and recovery improvement.
     I took the first instruction class in the USA in
Los Angeles given by Dr. Semm for laparoscopic surgery, which included live practice sessions
using the special laparoscopic instruments.

     After the battle of introducing a completely
new type of surgery into our hospital surgery department and creating surgical privileges for
the procedure was won, the privileges conflict
didn’t end for another year or so.

     My friend and associate in practice (who had taken the same training in Germany a few months earlier) were forced to buy all the surgical equipment ourselves, and then train all the OR nurses about the procedure.

     After tolerating the severe skepticism of all
the surgeons and medical staff, and continuing to add new procedures to laparoscopic surgeries that we performed safely in increasing numbers,
things slowly got better.

     Within the next 3 years the hospital bought
the laparoscopic equipment from us and ordered more, a new young surgeon started doing laparoscopic gall bladder removals, and the skepticism totally disappeared.

         As you might have guessed, it didn’t take long
before he was overwhelmed with patients who needed gallbladder surgery (other surgeons lost those cases), and overnight all the other surgeons scampered to learn how to do it themselves.
     I believe I was lucky to see the eventual value
of laparoscopic surgery from the start, to survive
the grind of implementation, and to have a
forward thinking associate who felt like I did. Advanced laparoscopic surgery became my
primary practice focus and fulfillment.
     Obstetric forceps deliveries were a critical and important skill taught during OBG residencies in
the Philadelphia medical community in the late 1960s (my OBG residency 1967-70).

     C-section rates were rising, but not much attention was paid to it. Fetal monitoring was a daydream in those days. I had become a sitting
duck for malpractice suits in California later when the whole specialty had changed, forceps use
almost disappeared, C-section rates skyrocketed, medical  malpractice suits increased.

          I was forced to put away my forceps expertise, and increase my reasons for doing C-sections,  completely contrary to my training. The move to increase C-sections was then subject to constant academic ACOG standards demanding reduction of C-section rates everywhere in the nation. It was a catch-22 situation that continues to today.

     Remember that we all are responsive to our mental fixations and that directly affects
our destiny.

   I had previously just spent five years as a
Navy military physician, then the next three years
in a civilian teaching hospital residency program, then the next three years in California at a Kaiser HMO during which time malpractice was never an issue. And in reality, almost forgotten about. Malpractice cases occurred but it was always
silently taken care of by the institution employer.
     My next step deeper into the quicksand was to begin my medical practice as a Kaiser Permanente doctor in California with at least two tripwires. The doctor environment in California was and still is
first in accepting new medical treatments and changes that advance medical care. Second, was
and still is a fruitful bed of aggressive medical malpractice attorneys.
    Once I began solo OBG medical practice, my
mind was on many other more important things
than potential malpractice actions and practicing
in a defensive mode right from day 1.

         A prominent malpractice attorney told me that
an OBG practicing in California at that time had a risk of a malpractice suit every three years on average.

    By this time the American College of Obstetrics and Gynecology was continuously publishing
articles and practice protocols insisting on
reduction of the rapidly rising C-section rates (a common defensive way to avoid obstetrical
delivery hazards and malpractice risks).
     My primary practice hospital, as many others where I was on staff, did the same. Hospital OBG departments published the C-section rates of every OBG and Primary Care doctor doing deliveries.

         At that time the C-section rate at our hospital ranged from 10% to 44% among 15 doctors. Nothing adversely ever happened to the one 44%
C-section physician, other than a little embarrassment at the time the statistics were released each month.
     Feeling confident about forceps deliveries enabled me to remain at the low end of the
C-section rates which drew much criticism from
the other OB doctors. These other OBG doctors
were younger and had very little forceps delivery training, so delivery by C-section indications were easily over-stretched judging by how I had
been trained.

     I had great belief and trust in the training that
I received from my professor, board examiner, and Chief of OBG at the teaching hospital in
Philadelphia. Avoiding C-sections by the use of forceps when indicated seemed well supported by ACOG and the medical literature at that time.
     After my use of forceps and a malpractice lawsuit, I finally kowtowed to the majority opinion
to disregard what ACOG advised and completely disregard what the hospital statistics said about
high C-section rates. I had done the right thing by official guidelines but had violated the unwritten
law about avoiding malpractice risk regardless of consequences that still permeates the
specialty today.

     This catch-22 situation will persist until the government takes complete control of medical practice, as we now expect to happen.

     I’m sure that you can relate to many of these factors here that were caused by my lack of due diligence in my profession. I failed to seriously research, consider, and evaluate each step I took along the way. I failed to see the wider view of my options and alternatives until forced to comply.

Due diligence is an intelligent way to avoid these hazards 

         Stop doing obstetrics and spend full time on gyn is another trap most OBG doctors get caught in. Contrary to my medical school thinking about this issue, later in my private practice I made a decision to quit OB and just work in Gyn.

          It made sense in view of the highest malpractice risks associated with any medical specialty in California. It is still true over many areas of our country today. It killed me because of my lack of due diligence.

     Starting a separate category of medical practice, like my doing only gyn, in my opinion is a major mistake. At least for my specialty the reasons for knowing that, are…

1. The major money earner (about 70%) for OBGs is obstetrics. Quit obstetrics and you leave well over half of your money on the table.

The only means of overcoming that is to have one hell of a referral system already setup. I never knew this at the time I made my emotional decision. If I had had a good business education, those facts would have been
easily visible.

2. If a doctor wants to retain certain options for later in his or her medical practice, you must create a plan to make ready for the change long before the change becomes necessary. If not, you will become a medical vagrant or railroad jockey.
     The problem of changing the focus of your medical practice is much easier if you can persuade yourself to make the change within the first two years in private practice.

That means it should be done before you have fully established yourself in the local community, haven’t yet developed a reputation that might offend the medical community, and before you experience a medical
malpractice problem.
     Statistics and surveys have proven that about 60% of your new patients are a result of referrals from other physicians. Now you know the importance of what I just said above.

     It’s best to make the decision at the start of any kind of medical practice.

3. Patients do not like to be dumped. It happens when you shift the focus of your practice well into your career and in the same community. Change your practice focus and move to another location produces a much better result.

  By doing that you have time to find a place to practice where you can rapidly restart a new practice loaded with the necessary factors that guarantee
your success.

      What you need to know here is what you have to learn in a marketing and business education, unless you have
a mentor.

     That’s another reason I advise that formal business and marketing education be provided while yet in medical school.

     This is another critical mistake doctors make in choosing a place to practice after their training is complete. The excitement and desperate need to get started often leads to an emotional decision, not a strategic decision.

          When you learn that everything is constantly changing, you cannot rely on old promises made to you about, “Come practice with me.”

     The persistent rewards from diligent investigation of every option you have done first will make you a happy doctor. Due diligence goes far beyond the
usual remote access of professional information.

         Goggling the name of a town for practice info and talking to at least one doctor in the area you are considering practicing in without visiting the area personally, is a huge mistake.

     Diligence is the process of obtaining the facts, not opinions.

Diligence is actually the process of proving to yourself that the facts and information you have recently accumulated are undeniably true and have all come from known reliable sources with legitimate information.

     There are many more important applications of using your due diligence during your medical career which I
will dwell on in my next article coming soon.
     Never underestimate the importance of using
diligence in every aspect of your life. I believe the time
you take to do this the more your decisions will
accomplish for you in your profession and life.

     In this fast moving generation time becomes more important. When you delay, procrastinate, and avoid
those decisions while wasting time, you create more barriers than your may think or even recognize.
Shooting yourself in the foot frequently is not the most productive way to live, and it certainly hinders your
speed for keeping up with those in competition with you.

     I believe Lee Iacocca, former general manager of
Ford Motor Company hit the nail on the head when he said…

“The trick is to make sure you don’t die
waiting for prosperity to come.”



 Business Nudges...

                                     alligators going after parachutist landing in water
Here is a very focused example of what happens to doctors who fail to use due diligence throughout their medical career. There are
unintended landings in dangerous territories with great risk to your medical career. Using due diligence
is a tool that will reduce the risk of injury from every decision you make in your life and profession.

Learning to approach every significant and important medical practice issue with adequate diligence insures that you won't fall into the traps often caused by emotional
rapid decisions. Get used to applying that tool before decisions are made and your career will be far more
fulfilling and satisfying.


photo of Dan Kennedy, 
                                                  world-renowned business expert


 How To Lead & Live
A Disappointing Life
(Told No, At Every Turn)

Duck, duck, oops. By now, the Ducky Dynasty controversy sparked by patriarch Phil’s raggedly voiced, Biblical based anti-gay answer to a GQ MAGAZINE interviewer’s question is old news. I wrote this when it was dominating media. A&E pretended they were shocked, despite a record on Phil’s beliefs dating back at least ten years.

That same week, a PR person (of all things) 146-charactered a tweet taken as racist by many and stupid by many more when waiting to board a flight, and she was publicly, “loudly” fired before the flight landed. Anybody  with any business, brand, career, money or reputation to protect who tweets at all is dumber than a pile of manure.

But these days, people like ‘ol Phil have to be “on guard” at all  times or know they put their empires at risk by voicing their opinions. My speaking colleague of 9 years, Zig Ziglar,
had exactly the same position on this item as Phil, but never,
to my knowledge, pushed it as in-artfully. Nor would he have agreed to be interviewed by GQ. (Reminds of President Jimmy Carter’s asinine agreement to being interviewed in Playboy, where he made a remark that created a firestorm at the time.)

Whatever you think about Phil’s statements, you should know that  your opinions or beliefs are every bit as offensive to a
whole lot of folks. A society where opinion is dangerous is a dangerous society indeed. Of course, Phil and his family are
rich, they have militantly loyal and enthusiastic fans, and this may wind up making them richer, not poorer. He handled
it perfectly.

Several people sent me Phil’s book, HAPPY, HAPPY, HAPPY,  as a gift, and in it I found a story, that is absolutely   typical and representative of two truths behind most Renegade Millionaires. One, what my friend Glenn W. Turner called “being intelligently ignorant” – too dumb to know something can’t be done, and doing it, often to the shock, dismay, and occasionally, rage of “smarter” folks.

Second, living undeterred by being told “No”.  So, here’s how Phil “cracked” Wal-Mart for his duck calls…

“So, one day I pulled my old truck in front of the first Walmart
I saw, walked in, and said, ‘Hey, how many of these duck calls do you want here?’ The clerk laughed and told me, ‘We don’t buy duck calls. Son, you need to go to Bentonville.’ (Wal-Mart corporate headquarters).

I drove down the road and tried the next few Wal-Mart stores... finally, one of the store managers said, ‘You got an order
form?’  ‘Nah, I just figured you could pay me out of petty
cash.’ ‘Well, I’ve got a 3-part form I need to fill out,’ he said. ‘I’ll try six of them.’ When that store manager filled out his 3-part form with WAL-MART at the top and wrote down ‘six
duck calls’, I walked out looking at my copy and thought – 
I’ve got me something here.

When I got to the next Wal-Mart, I showed the store manager
the form and told him, ‘Walmart’s stocking duck calls. This last store ordered six.’ He said, ‘Give me what you’ve got.’  

Eventually, Phil had sold $25,000.00 worth into Wal-Mart stores. Finally, the chief buyer at corporate called and wanted to know how this had happened, and Phil told him. The buyer said, “Let me get this right. You mean to tell me you’ve been driving around in your pick-up truck and convincing our sporting
goods departments to buy your duck calls without even conferring with me, who’s supposed to be doing the buying
for the whole Wal-Mart chain?” 

To his credit, the buyer gave Phil a letter officially authorizing him to keep doing what he’d been doing and okaying store managers’ purchasing. About a year later, Phil finally went to Bentonville. Storewide sales averaged $500,000 a year for 20 years, and opened doors at Cabela’s, Bass Pro Shops, etc., and went a long way to making Phil and his family rich. How many Phil’s do you think accept the first no?

This mirrors the story of Kenneth Cole, and the way he
launched his shoe company – which I’ve told often. Everything else swirling around Phil now is irrelevant. Just focus on this specific  aspect of his thinking and behavior: that normal
and customary ways of doing things  are for other people.

This  is how big things get done and big money gets made.
Most environments – Wal-Mart included – have a bureaucratic rule book in place, bureaucrat keepers of the rules; a stultifying  process that preserves their power and deliberately renders all others supplicants.

Most everybody accepts this, most are confounded by it, some fight their way through it like the lone cat of the six stuffed
into the same burlap sack tied shut and dumped into the water trough, who claws and bites and fights his way out. (This has long been a common form of population control of cats
on farms.)

A few people refuse to accept this. A few ignore it, out of intelligent ignorance, renegade nature, and an instinctive or conscious recognition that being in a tied-shut sack with competitors, submerged in water, and fighting to be the only
one to survive is an undesirable game, even for the victor. A whole lot of what I’ve done, do and teach about
marketing, selling, entrepreneurship is  all about  never
getting into or being put into the sack with the other cats, submerged in water.

At every turn, the person of accomplishment and wealth was
and continues to be told “No”, “You Can’t” and “That’s Not
How It’s Done Around Here”.  Metaphysical-leaning thought leaders teach that this is how “the Universe” tests the truth and depth of each individual’s desire:  a long line ahead of them, in front of a thick, wood door with no bell, through which timid knocking is never heard, and to which a few react: why bother with the damn door at all?  

Test of character and will or simple fact of life, you can decide. But life is  most profoundly and consistently disappointing for those who honor bureaucracy, who accept No.

NOTE: To receive $633.91 of free money-making marketing
and sales information from Dan Kennedy and GKIC simply
click the link below. p=drgraham

DAN S. KENNEDY   is a serial, multi-millionaire entrepreneur; highly paid and sought after marketing and business strategist; advisor to countless first-generation, from-scratch multi-millionaire and 7-figure income entrepreneurs and professionals; and, in his personal practice, one of the very highest paid direct-response copywriters in America. As a speaker, he has delivered over 2,000 compensated presentations, appearing repeatedly on programs with the likes of Donald Trump, Gene Simmons (KISS), Debbi Fields (Mrs. Fields Cookies), and many other celebrity-entrepreneurs, for former U.S. Presidents and other world leaders, and other leading business speakers like Zig Ziglar, Brian Tracy and Tom Hopkins, often addressing audiences of 1,000 to 10,000 and up.  His popular books have been favorably recognized by Forbes, Business Week, Inc. and Entrepreneur Magazine. His NO B.S. MARKETING LETTER, one of the business newsletters published for Members of GKIC Insider's Circle, is the largest paid subscription newsletter in its genre in the world.

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You lose money every day in your medical practice if you have not listened to what I tell you to do. Who else will tell you how it happens… this price?

Profitable Practice

Consider hiring a medical scribe to handle all of the needs of the medical bureaucracy.

2. Begin marketing your medical practice....the drugstores are now, with their mini-clinics venture into healthcare they are your competitors.

Borderless Humor

"I had a rose named after me and I was very flattered. But I was not pleased to read the description in the catalogue: No good in a bed, but fine against a wall."
---Eleanor Roosevelt

Goals - Plans


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"Do we not all agree to call rapid thought and noble impulse by the name of inspiration?"

---George Eliot

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What my medical career taught me...

Click Here... and how it can help you manage your medical practice business at the highest level of expertise.

 Facts And Stats

1. From 2011to 2012 the median hospital price increase for 100 common service types was almost 5%

2. New painkiller, ZOHYDRO, an extended hydrocodone drug, in court to reclassify it on a level with heroin.

3. California attorneys are pushing for a ballot initiative Nov. 2014 to increase the cap on medical malpractice cases to $1.1 million dollars. The cap since 1975 was set at $250K.

What Your Kids
Are Capable Of...

Insist on and help your kids to become assets...

When you want to understand
what your modern day kids are
capable of
and have
the ability to do,
regarding starting a business of their own, then hit the link below and give yourself a dose of inspirational enlightenment...


Teach your kids these things...

business principles,
--creative thinking,
--decision making,
--goal setting,
--faith in God,
the power of money

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red checkmark you just don't know where to turn to get honest and reliable help with your battle to fight the external forces that compromise your practice revenue and growth.

red checkmark you want to improve your medical practice income dramatically in a short period of time.

red checkmark you prefer to find the means to reach your highest level of practice income and productivity.

red checkmark you demand effective and reliable means for preventing the financial collapse of your medical practice.

red checkmark you are determined to find ways to combat govt. fee restrictions that continue to increase.

red checkmark you recognize that what you are missing in your medical business are implementation of business principles and marketing strategies.

red checkmark you want to do it yourself and save a bunch of money.

red arrow pointing to right you are sick and tired of putting up with what you are being forced into doing with your practice to stay afloat.

you are aware that no other physician author is making any effort to tell you what to do and how to do it effectively to reach your expectations you had for your medical career when you started.

red checkmark you understand the severity of being in a business without ever being taught the business knowledge to run it profitably.

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References For Maximizing Your Practice Income


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bird laying on its back with feet up in the air--giving up


    Dr. Graham and two corpsmen--Vietnam 1965   photo Dr. Graham 1977    photo Linda, Dr. Graham's wife    photo of Dr. Graham  photo Dr. Graham with his 5 medical practice associates    

Flight Surgeon Vietnam
1964-65     Dan-Curt-Dave

Diet Worked 1980

 My Wife Linda

Retired 1999

My prior Medical Practice Group...
Graham, Mayo, Kaplan, Seibert, DelValle, Chuba

masonic insigniaAmerican flag imageCurt Graham, M.D.
2404 Mason Ave.  Las Vegas, NV 89102
E-mail = cgmdrx(at)gmail
© 2004-2015  Curtis Graham, M.D., All Rights Reserved.