Medical Practice Business Ezine Newsletter      Jul. 2014

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"Advanced Medical Practice Business And Marketing Profitability Strategies"

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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 #55 - Jul. 2014 

“Due Diligence Is Not Something You Think About,
It’s Something You Do… You Might Call It Personal Analytic Research” (Part 2 of 2)

 Regrets about the medical practice situation you have emotionally decided to place yourself in, is just the tip of
the iceberg when it comes to disregarding the most
valuable tool you will ever have access to
during your medical career.

     In part 1 of this article you found that lack of adequate diligence is a sword that cuts deep into your life as well as your medical career. The real life examples you read about demonstrated some of those tragic, sudden, unexpected, unintended, and practice altering consequences that can sweep
up on you like a tsunami.
     The focus in the first half of this article covered diligence pertinent to high school, college, and medical school factors. This last half I want to present to you some very helpful ideas about due diligence covering medical school and all that follows in your medical career.
     It isn’t something you hear about rarely or at all. But it has a great deal to do with the major part of your medical career and
the ultimate success, enjoyment, satisfaction, lifestyle, and family relationships you have while in your medical practice. 

Diligence advice for selecting a place to practice medicine...

     Selecting a place to start a medical practice is just as
important to your medical career as your passion for practicing medicine. Farmers plant crops in the best soil they can find for good reason. It’s no secret that the harvest is multiplied by doing that. And there’s one more important ingredient, that of choosing the right seeds to plant that grow best in that kind of soil.

     Taking this simple lesson to mind, every smart doctor with an eye to the future understands that their best soil to plant their new medical practice in requires the demographics that enable
the persistent production of harvested medical patients
demanding the special kind of medical care that that
physician offers.
     Unfortunately, well over 90% of medical doctors start their medical practices in places that they “think” is right for them,
that is based on emotional feelings, family influences, area conveniences, educational opportunities, and etc.
     The simple business view about medical practice survival encompasses having increasing numbers of new patients demanding your medical services from the beginning of your practice to the end of your medical career. And every doctor at least subconsciously wants to avoid being forced to move their practice, sell it to the local hospital, or make major alterations in their medical practice years later when healthcare mandates require it, such as we see hitting the medical profession today.

     In order to give yourself and your medical practice the most reliable and long term supportive conditions for profitability and growth, you can either make it happen using due diligence or
let circumstances run your career for you.

     The enigma associated with most doctor’s relying on their “thinking” rather than their “doing” the right business thing for locating their medical practice is the result of the lack of a
business perspective that comes to mind only when you’ve had
a business education at the start. Doctor’s just have not been given the ability to think in business terms and it results in formidable consequences for most.

     If you’re lucky, you may already be a diligent person in all
that you do. If not, then you will have to work at it by practicing diligence approaches to all your medical career decisions. That way, you’ll survive to smell the roses. You might even feel the freedom to tear-up your monthly social security checks… well that’s a stretch. 

What you were never taught about due diligence  

     About the closest that most people usually get to practicing diligence is when they decide to buy a house. Even there, most
of the diligence is done by the real estate agent showing you the information. In a sense the realtor is your mentor. Maybe, you could use a mentor to help you with your medical business
decision making?

     My clients (physicians) seem to believe it’s important, especially when they lack the business knowledge to put all the important factors into understandable decision-making formats.

     Physicians who are most astute about business challenges
are those older doctors who on their own have tested the
business market by investing, accumulation of business expertise over time, and other kinds of business ventures and discover
how much knowledge about business they don’t know and how much they needed to know.
     Interestingly, most doctors don’t seem to catch-on to those nuances from their own medical office businesses. Contacts with the business world outside their own business seem to do
the trick.

But, let’s move on to the practice of diligence...

     I’m probably the primary example of a physician who traveled through all those years in medicine and in my life without ever applying a twit of diligence. No one ever taught me about it or about the consequences of not using it routinely. It was all emotional decisions. If I had picked up on that myself, I likely would not have chosen to become a physician. Or, it could be a supernatural guide.

     We all seem to have more than one passion in life to pursue if the circumstances tilt us in that direction. You could probably
could have been successful in several other professions if you
think about it. Just look at physicians you know that quit
medicine and are happy and successful in other careers.

     Anyway, giving yourself permission and time to do your own diligence always leaves one with more confidence and certainty. When you choose a place to practice you want it to be a permanent thing. However, the massive changes in the profession over time and how it has upended most medical practices over
the last 6 decades, presents a very good reason for every doctor
to have a backup plan for their medical career… just in case.

Some important diligent steps to take when choosing a practice location...   

  1. Start investigating at least 5 different locations two or three years before you intend to start your medical practice. You
    do that because you have time to really take a close look at each one and it gives you time to reconsider the area
    because of your mind changing patterns as you get closer
    to the time for the move. Opportunities spring up suddenly.
  2. The areas you have chosen should be entirely focused on
    and about your practice business success. If not, then you
    may set yourself up for disappointment. There’s a reason
    that studies have shown that at least 14% of doctors move their practices each year… that’s one in about 1 in 8 doctors.

Research these important practice-success influences... 

  1. How many physicians in your specialty are practicing in that area? If you find that there are more than 1 per 10,000 general population, it’s likely you will snuffed by the competition… but not always. Much better to start in an area with a ratio less sparse in your specialty.
  2. Area population: Rural areas may fit your desires, but in specialties other than primary care, your chances of doing
    well require a city population. Primary care doctors in rural areas accept the fact that their patient flow, practice income, and patients with health insurance coverage are at the low
    end of the income scale.

         The reported average salary of primary care doctors is around $80,000/yr. Referrals to specialists is difficult
    because most are 100 miles or so away and small rural hospitals are going bankrupt by the thousands.

         Cities are the locations of most specialists for good
    reason. Even then, the ratio of doctors to population is important.
  3. Healthcare coverage: You want to know that the medical patients you are servicing can pay their medical bills… or at least have reasonable health insurance. You look at the industries and companies in the area that provide health insurance for their employees. What’s the primary source of income for the local population?
  4. Hospital facilities and labs: If you are a specialist, you need
    to know that hospitals have the equipment, tools, surgical equipment, and laboratories that fully support your specialty, unless you don’t need hospitals in your practice.
  5. Referrals: Call the doctor specialists in the local area and ask them about referral situations, availability, local referral
    habits of doctors there. Since about 60% of referrals you get are from local doctors, it’s important for you to know.
         Almost all doctors end up referring most of their patients
    to one or two doctors they like. So, you have an opportunity
    to break into the habit pattern by doing what others are not doing… going out of your way to entice doctors to send
    patients your way. If you don’t ask them, they won’t send
    you patients. Take my word on that.
         A dynamic patient referral program you create for doctors to refer patients to you is a fantastic way to build your
    practice faster and earn a higher income. Most doctors today have no clue how important this is to do.
  6. Overflow referrals: Long established doctors often have overflowing numbers of patients they can’t handle. By calling local doctors in your own specialty in the area you can
    usually find those who will refer you patients now and then. Once patients report back to them that you treated them unbelievably well, you’ll get a lot more referrals from them.

         It’s how I got started in private practice and was exceedingly helpful in growing my practice.
  7. Real Estate and cost of living: Will you rent office space and what will it cost you in comparison to other cities? Will you rent a home or buy a home for you family? Knowing as much as you can find out will help you decide what to do ahead of time. You can compare the 5 areas you picked out
    to investigate.

         Studies have shown that cost of living and housing is lowest in the Midwest section of the country. Less medical practice competition is another advantage of the Midwest.
         Net incomes in the Midwest are greater for doctors than coastal areas of our nation.

Research on family factors and amenities 

     The necessity for making your family life an awesome experience is of maximum importance and must fit into your and their interests, hobbies, education, and etc. Divorce is more common in physician’s families because doctors are overly
involved in their medical practices and earning more money. So, having a way for other family members to have good extractions that sooth the mind is advantageous.  

  1. Education: School systems are not all equal in quality. Parents need to know that their children are being taught by excellent teachers. Having a college or university nearby is always a positive. Parents take night school courses, spouses can earn a college degree or finish up one they started elsewhere, and having your kids attend college locally saves money and worry, all figures into making everyone happy.
  2. Sports: The benefits of participating in sporting ventures can be very important to families who love to do certain things. Skiing is a sport that becomes difficult if you live in Florida. Attention to what’s available nearby relating to sports may
    be the final deciding factor in your practice location.
  1. Travel: Living in a city having air travel connections nearby for a family that travels a lot is a great convenience and time saver over the years. Most doctors take a few days off to
    travel to medical conventions, for short workshops learning new skill techniques, and other educational endeavors. In
    that case one can avoid driving a full day each way to and
    from an airport which allows two extra days for seeing
    patients that would otherwise be wasted on travel.

     Once you have done this kind of research on each of the 5 potential practice sites, you should select the two most favorable sites and travel to each, preferably with your family. Meeting up with a few of the doctors you had good conversations with previously on the phone will establish connections to be
used later.

     That meeting in person does more for your decision making than a hundred phone calls. You find out facts that are never discussed over the phone and get a much better feeling about
the community in general.

     When you settle in the same city where you trained, the
whole process is easier. You often will have practice offers and other meaningful help than you otherwise would probably not
find at a distant location.

Diligence helpful in decisions about your practice structure...

      This is another instance where one can start a couple years early to make some preliminary decisions about whether you
want to go solo, join a partnership of one specialty, or join a
group practice. Starting the process of looking for those opportunities, doing interviews, and getting a feel about your comfort level within the framework that is already functioning
is mandatory.

Working solo to start is often a better approach for several very good reasons...

  • You have the opportunity to make all the decisions yourself. Groups and partnerships already have the rules they abide
    by and you then have to be compatible with working under
    those rules.
  • When you first work solo, the other doctors have a chance
    to see how you practice, how you treat patients, know your personality, experience your quality and knowledge about medicine, and can judge how you might fit into their
    organized group.

         The danger of joining a group to start with is that you
    don’t get to judge the qualities of the doctors, their personalities, and their compatibility issues until you have already joined and committed to their ways. Incompatible personalities make it much harder to practice medicine with because of frequent conflicts.
         That issue was why I quit my “call group” after 10 years with them. We voted on bringing another doctor into the call group and in a couple months he and I clashed, verbally.
    I quit the group that day. Three months later he quit the
    group and moved back to the east coast.

         One of the other doctors in the group had developed
    some rigid ideas about delivering my patients for me when
    he was “on call” for the group. So I did not re-join the group even though I liked them all and trusted them all completely.
    I just couldn’t let the one doctor deliver my patients any
    longer when he was on call… his C-section rate was
    about 50%.
  • Every organized group of doctors is unique in most respects. Each has their own beliefs, thoughts about ways medical practice should be managed, how the leadership of the
    group is established, who decides what should be done and how it should be done, and how responsibilities of the
    practice are assigned.

         Because they are all different from each other, meeting
    all the group members in person is mandatory before joining. First impressions are most often correct, but you don’t have the time to learn to know and make allowances for the one that you are concerned about. Join one where all first impressions are great.

         Most new doctors who join are put on a salary and trial period. After a year or two, along with behavior, you may
    be invited to become a full partner, or at least get an
    appropriate increase in salary on a level with the other members. Have your own attorney review the contract with you before you sign it.

         Solo practice time first shows everybody your “stuff.” It results in the weeding out of doctor groups that know you would not be compatible with their group.
  • Sometimes, you may be offered an apprenticeship type of practice. You go join an established doctor who needs help
    with his large practice and are given a percentage of the
    gross income earned by the practice. After a year or two,
    you can be offered a partnership or move out to your
    own practice.

         I have seen this work very well for new doctors to earn enough to pay for starting their own practices. As you know, doctors finishing residency are usually broke financially.
    I did this out of my residency as an employee of an HMO.

         It was a good learning experience for me, and a lesson.
    I discovered that I hated being told what I couldn’t do in medicine and I couldn’t tolerate shortchanging my patients
    on a routine basis which is how HMOs make money. I discovered also that certain attitudes commonly found
    among employed doctors were intolerable to me to be
    around all the time.
         Up to that time, I thought I had always been the most tolerant doctor on that side of the Mississippi River. Finding myself out there in the practicing side of medical practice exposed me to the raw side of medical practice that I hadn’t previously paid attention to while in the carefully guarded behavior of academic environments.

         I’m pretty sure that my previous recent combat military tour with the Marines in Vietnam had something to do with
    my intolerant attitude towards wise-guys in medicine. You think? Being spit on by the public who were against the war when I arrived home was a real surprise for me and other soldiers that served there. That chip on my shoulder is still there to some extent today. You can’t hide it, but you can suppress it.

         The two year trial run of medical practice enables you to make much better decisions about your future career
    in practice.

     Using due diligence in every aspect of your medical practice
is what creates great rewards in your medical practice because
it permits close and deep investigation of every alternative prior
to deciding on the next step.

     Goal setting from the small goals in the beginning leading to the one final ultimate goal you have for yourself and your career
is what enables you to maintain your focus clearly and continue
to excite your passion along the way.

Doctors who disregard appropriate diligence are everywhere...

     Most are physicians who have a difficult time making decisions for themselves, yet have no problem making decisions concerning diagnosis and treatment their medical patients. I don’t know why that happens. I do know that it involves an issue commonly found in marketing products.

     It has been proven that giving a customer several choices of
a similar product to buy often deters them from buying any of
the choices. In a study on selling “Blue Blocker” sunglasses, when
only one product is offered there is a greater chance that the customer will buy that product. Too many choices, alternatives, and options confuse people. Doctors behave in the same manner and have too many options to choose from I believe.

     The psychology with this must involve fear of making the wrong choice and suffering the consequences so they continue on jumping during their careers from one goal or mission to another. They remain unsure and keep looking for the perfect opportunity.

     This may also contribute to the cause why 14% of doctors decide to move each year.
     Of course, there are many other reasons for jumping around, from divorces to being fired from your medical employment position. Some doctors make all decisions purely by emotion,
quick and definite, without considering the consequences of that decision. It may be because of their overconfidence about being able to handle any and all consequences that show up.
     Regardless of a doctor’s personal reasoning about decisions, decisions made without due diligence often lead to some degree
of medical practice failure. It includes things like financial failure, slipshod practice management that compromises patient flow,
slow or no growth of their medical practice, mental stress far above the usual stresses of medical practice, disappointment
with their career, family problems, and others you can name.

     The problem is to get all physicians to use diligence more
often, more thoroughly, and more seriously for themselves.
About the only way I would have learned that tool would have been when I was a teenager and taught to me by a person I
highly respected. It’s a tool you may want to teach your
own children.

     Diligence is something that people must learn the
importance of and learn what it can do for their own benefit.
It is a learned habit, not related to intuition.  


      If all medical students actually applied due diligent attention
to their eventual practice of medicine, they would be storming
the office of the Dean of their medical school screaming for
formal business education during their four years there.

     Where are all those medical school education activists that
are supposed to be carrying signs and parading on the school grounds in front of the medical school shouting educational obscenities at the top of their voices?
     OK… my imagination is running out of control today. But, wouldn’t it be fantastic if that demonstration was exactly what
the Dean needed to push for a decision to provide a formal business education that he had already had in mind?

handwritten signature of Dr. Graham


 Business Nudges......

photo of sick young boy, thermometer in mouth, cold pack on his head
If your medical practice is sick from the lack of due diligence, you are not too late to strike a course towards using diligence from here on in.

Without having a background in business education as most of you don't, it's no surprise that the importance of a business education is the last thing on your mind. But, as you continue on in your career you will feel the sting from the lack of that knowledge more and more.

It's not too late to study business principles by reading what business experts are teaching about and what is required for true business success in any business. Only then will you begin to recognize what you were never told nor taught. Only then will you understand what you "don't know" and should have learned long ago. The advantages and potential for using these ideas even for one year of medical practice will astound you.

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In Every Issue

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 Tips

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


Inspiration Time

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

---George Eliot

Views I Only Share With My Friends--

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

New Important

Protect your practice using the strategies in this
 Ebook, which  contains the keys to your medical practice survival.

"How To Rapidly Propel Your Medical Practice Income To Unlimited Levels In 6 Months"
Click Here When you need expert help and advice, and when........

red arrow pointing to rightyou 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 arrow pointing to rightyou want to improve your medical practice income dramatically in a short period of time.

red arrow pointing to rightyou prefer to find the means to reach your highest level of practice income and productivity.

red arrow pointing to rightyou demand effective and reliable means for preventing the financial collapse of your medical practice.

red arrow pointing to rightyou are determined to find ways to combat govt. fee restrictions that continue to increase.

red arrow pointing to rightyou recognize that what you are missing in your medical business are implementation of business principles and marketing strategies.

red arrow pointing to rightyou want to do it yourself and save a bunch of money.

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

red arrow pointing to rightyou 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 arrow pointing to rightyou understand the severity of being in a business without ever being taught the business knowledge to run it profitably.

red arrow pointing to rightyou insist on having a blueprint for your medical practice business that provides every key to your practice success at the highest level. 

References For Maximizing Your Practice Income


My Other Medical Websites 





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