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Private Practice Advice....

From a doctor who has nearly 40 years clinical experience to share with you.

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Medical Practice Insights 2016

Medical Practice Insights Archives from 2010 to 2015 can be
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 May 2016  

Topic: "Doctors can't buy something they don't know exists."

It seems to me... One of the major factors that college premeds, medical students, and physicians have been completely ignorant of the value and need for a business education is because they have in the past and even today don't know that business education exists for them to make use of.

You see, because they have never been made aware of the alternatives for obtaining a business education along with medical school and while practicing medicine, they don't know that such a thing exists. Probably the majority of medical school students come to the realization that business knowledge has value for them and their careers... but just don't see where they can fit it into their busy education. So they go on thinking that they have to stop their medical practice to get an MBA, business education, or a comparable business learning experience.

There are so many disbeliefs about a business education for medical students and how to offer such an education in medical schools, that it staggers the imagination. The preparation and introduction of premeds to the value of a business education in not part of their curriculum... thus preventing them from an opportunity for a business education while still in college, when they do have the time and opportunity to learn business essentials.

If medical students were honestly told the truth about how much a business education would improve their medical careers, they would storm the dean's office demanding that the school offer that to them, at the very least.

I can foresee that such a business curriculum will be developed in the future for medical students even though I likely will never be able to reach a point where medical scholars will listen to me and what I know is needed.

I have even asked the Lord to help me push this concept into existence sometime soon.

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 Apr. 2016  

Topic: "I get angry every time I read medical professional articles in the major medical practice magazines about how doctors should manage their private medical practice, make more money, become more efficient, and leaves them feel hopeless"

It seems to me... that every author of virtually every article I find lacks the insight into every private practice physicians life to understand what the core problem is and how it is destroying medical practices nationwide. I'll go so far as to say that over 90% of the advice given is either common sense, already understood by doctors, or the advice comes from those with absolutely no business education at all themselves.

I always look for the words in those articles that reveals the truth about the financial failure of medical practices... but rarely do I find them. Of the hundred articles I've read in Medical Economics, Physicians Practice, Medscape, Modern Physician, among others, I can't say honestly that I've read one article where the author has written about the need for doctors needing more business knowledge, business education.

It is astounding to see and read how often these authors miss the mark, go off on an unnecessary tangent of practice that doesn't help them financially, and are deficient in directions about how to use the advice they give to doctors. Actually, it seems like a universal conspiracy to avoid telling the truth about the fact that a business education is necessary for any doctor to reach their maximum profitability, productivity, and value to their own patients.

I've met a few medical doctors who have found the truth on their own and are multimillionaires, not because of how great they are practicing medicine, but because they discover that medical practice is a business, and run their practice as a real business should be run. How hard is that to understand?

If private medical practice survives the predators seeking to control healthcare, there will be an increased requirement of all those doctors to have a business education to survive. After the eventual crash of our economy in the near future, employed doctors will have no jobs anymore or their salaries will be in the poverty range if they continue to be employed.

When a physician has a firm knowledge of business and marketing, they will light the way for those who lack that knowledge.

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 Mar. 2016  

Topic: "If not for you, do it for your kids"

It seems to me... it's too late to try and break the century long erroneous fixed mindset of physicians that business knowledge has little or no value to doctors. Doctors now in private medical practice are just going to have to put up with the increasingly severe consequences resulting from the lack of good business knowledge. In early days under the umbrella of rare competition for patients, knowing business principles wasn't much help for income or prestige.

That consequence has long disappeared. Now, without business knowledge, private practices will flounder from the competition, fee restrictions, medical practice mandates, and medical patient adversity. Many practices fail. Most can't be helped without working with a physician that has an open mind to business advice. This enigma permeates the medical profession. I suspect as most physicians in private medical practice get old, they begin to see what a business education could have done for them.

The same problem will continue for your children unless you take the time to encourage your kids to get business knowledge, start a business, work with friends for money, and learn the powerful advantages that goes with having money. Get them to read books on business and marketing, send them to summer camps for junior entrepreneurs, take them to business conferences with you, teach them what you know about business. Get them a mentor for business education.

Remember, when you get old you may need to have sons and daughters to rely on for help and care. The better off they are and have become, the more likely they will have your back all the way. Who wants to use all the retirement money for medical problems and have none left to enjoy retirement. Suppose you are never able to fund a good retirement plan altogether because your practice income is so low. What good can you do for your kids then? Most doctors now seek employment and depend on salaries not understanding that salaries will also go much further down from what they are now. It's inevitable.

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 Feb. 2016  

Topic: "Physician employees--how they are used and abused"

It seems to me... that it would be helpful for you to know about some of the negative sides of becoming a physician employee. My 14 practice years as an employee should qualify me as a trustworthy person to hear these things from. (6 in military, 3 at Kaiser, 5 as a hospitalist)

In 1962 the military was drafting medical doctors right out of medical school to prepare for the Vietnam war escalation and the increase in military strength. My selection was the Navy. My belief was that it was better for me to get my required service out of the way first so that interruptions of my further specialty training would not occur. As long as I knew the Navy was my destination, I requested my internship in the Navy and would plan after that.

I elected to join Kaiser Permanente employment after my OBG residency in 1970 because I had no source of income for my family.

The choice to become an employee hospitalist in 1994 was a flip of the coin. I had lost my private practice for financial reasons and business ignorance, and recruited for a job anywhere, and ASAP. That spot in Michigan in the hospital's woman's clinic became available, I later discovered, because the hospital was unable to keep doctor's employed there in that clinic with 9 certified nurse midwives for any extended period of time. The clinic was under the supervision of a perinatologist/neonatologist doctor to keep the clinic open and compete with another local hospital for patients.

In the military a doctor has no real choice as to how they want to use you. As a flight surgeon it kept me out of the crappy clinic chaos for the most part. Naval aviation was a formidable challenge and enjoyed my time in it.

Kaiser was a completely different game. The major push was to make as much money from patients as possible to pay their doctors enough, and benefits enough, to satisfy their needs, and pump up the organization pockets. That essentially is exactly what all businesses are in business to do, and private practice of medicine business is no different.

I detested being told that I couldn't do infertility work there... health insurance didn't cover that part of healthcare. I had no control over my patient scheduling in OBG and was completely booked up 3 months ahead, no fit-ins, no medical care after clinic hours. it required seeing patients rapidly to keep up with my patient schedule in order to be done by 4 PM. I happened to be a doctor that felt an obligation to teach and inform my patients, and never had the time to do that.

At Kaiser I found that the OBG department group of doctors, about 10-12, that were long term employees all had personal non-professional reasons for staying. One doctor lived and preached golf. Another had family wealth and life was easy there, 9 to 4, no surgery, practiced with using the medical advice of other doctors in the group. Another has a fascination for heading the department administration.

In spite of the salaries, good benefits, retirement and partnership setup, and enormous amount of free time (compared to private practice OBGs) available to them, in my three years there almost half of the OBGs left for private practice, usually into a specialty group, and a couple had been there well over 6 or 8 years and quit. A couple of doctors came and went in a few months.

The Kaiser program I believe was ideal for female doctors, for those who needed a lot of free time to pursue their hobbies or pleasures outside of medical care. It brings up to me the question of why they actually chose medicine as a career. Maybe it was for the stability of income, the professional status, the challenge to see if they could make it, or the demands of their family (which is often the case).

My Michigan hospital tour of duty was perfect to pay off our debts accumulated when the practice disappeared. My experience working with nurse midwives was impressive. All were very competent in my opinion and well educated enough to know when to call for help from doctors. It made me a believer in CNMs and PAs for being an asset to medical practice rather than a competitor. Any physician today that does not take advantage of these assets in private practice is foolish. They are money makers for doctors.

The restrictions on practice placed on me while working in the hospital clinic were far more idiotic and extensive than at Kaiser. The lesson I learned at this job was something that I had suspected along the way in the medical profession, but never thought it was more than competitive personalities. I never had experienced such resentment, hostility, income competition, arrogance, and subtle examples of intentional disgust among medical doctors.

I then did some deep thinking about my experiences over the past 40 years and concluded that I was naive to think that these things inside the profession were rare events, when in fact it truly runs through the whole profession, varying only in intensity and aggressiveness.

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 Jan. 2016

Topic: "Ask any doctor... how many new patients did you get this
                  past month?"

It seems to me... their almost unanimous answer would be, "I'm not sure." or "It's none of your damn business." Would they just pick a number out of the blue to tell you in order to uncover their office business management incompetency? If you have a close relationship with them, they likely would be more honest about it and tell you, "I don't keep track of those numbers." So how many doctors keep records of new patients coming in and old patients leaving?

I never kept track of such things, didn't know doing it would be of any value, never heard or understood that doing so would have benefited me in any way, no one ever mentioned it to me to do, never heard a speaker during any medical conference mention it--and I never left the conferences in the middle of the session, my CPA and Corp. attorney never brought it up for me to do, and, worst of all, none of the medical school faculty or instructors ever mentioned the importance of business knowledge to a medical student or myself during the four years of school, or even in residency.

When I now look at what I was never told about managing the business of medical practice, it leads me to the conclusion that either the medical academic scholars having no business knowledge themselves, never knew themselves how important business knowledge was to every doctor, or that their omission of the truth about business education was a matter that they had no responsibility for teaching or providing. 

That takes me back to the fact that for a century the business side of the private practice of medicine has been relegated to the responsibility of the medical students themselves. And that it is no different, or is simply a continuation of, a students personal obligation to go to college, to choose medicine as a career, and did what they had to do to get into a medical school. Beyond that, their intelligence should tell them that because private practice means you have to know business to run the practice profitably and efficiently, they need business knowledge.

At the heart of this issue is that, like so many other necessary life functions, we have to be introduced to the values of and benefits of business knowledge first. Isn't that at the heart of all education itself? Why do we need to know reading, writing, and math? Would any child want to learn those if they didn't make a huge difference in their lives? Those elements have always been drummed into our minds, so having to know them is a requirement, and they told you so.

The failure in that process occurs because business is never taught from kindergarten through high school. Early on we never are alerted to the benefit of the more important life necessities... like business, developing relationships, working as teams, having to take responsibility for what we do or create, and having a work ethic.

Most everything we do in life requires money. All money is derived from some sort of business entity. So why do educational academics leave it out of the educational curriculum? It follows that graduate education has traditionally done the same thing. Is it politically correct to break tradition and provide business education? YES!!!!

Then why don't they do it? Traditions are held to esteem in the minds of people, countries, cultures, and races since human existence began. If the world around us is constantly changing, what happens to stagnant cultures and countries? They either disappear or become a problem for those who adapt to the changes.

I believe the reason for the demise of private medical practice is the result of the above factors. Adapting business education into the medical school curriculum is the means to save private medical practice.

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masonic emblembright colored American flag  Curt Graham, M.D.
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