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Medical Practice Insights Archives - 2011 thru 2015
Topic: How does Jesus fit into a physician's medical career?
It seems to me...at Christmas time we all in one way or another become involved with the thoughts and feelings about God and how He works in our lives and careers. The Bible has been the core of Christian beliefs for over 2000 years. This one book's content has changed and improved the lives of billions of people over time in a world continually laced in conflict. There is no other source of prophesy, beliefs, and truth that comes close to what the 66 books of the Bible teach us about the ways of life that result in actual love and happiness continually.
In essence, the 10 commandments of Christ enables each of us to follow as closely as we can with the promise of hope beyond death. In medical practice we witness medical miracles and cures that could never happen without the intervention of God. Christ's intervention, which is allowed only because of our free-will to believe in Christ's human life, crucifixion, and resurrection, begins before our conception and continues through life and our careers, to the degree that we believe in a living Christ and follow his advice.
As physicians we have been endowed with the talents and intelligence to treat and cure medical problems of our patients. We could not practice medicine safely and effectively without believing in God to begin with, a fact that is often overlooked by physicians themselves. And it is also something that is commonly never celebrated and that we forget to thank God for. This includes myself as well.
I've discovered and believe that when we look back through our lives, especially in our medical careers, all of the changes we've made and circumstances that caused us to make the decisions we've made have resulted in divine intervention to keep us on the right track for our purpose in life. In all cases in my life those inconvenient and often regrettable circumstances that forced those changes and decisions were to avoid catastrophes and problems we got ourselves into and never recognized it until later.
Even though I was church oriented by my family very early in life, I never truly understood my life and career choices until I decided one day in my 70s to sit down and actually read the Bible cover to cover, word for word. Since reading those 2,500 pages of my Bible, my life, health, mind, and purpose have become clear and understandable.
The interesting thing about reading the Bible that has surprised and overwhelmed me is the fact that I have read the Bible about 5 times since, cover to cover, and each time I read the same things again, my whole understanding and interpretation of those paragraphs are often different and more informative and believable. Another thing; I read a chapter or so every day (about 20 minutes) since then, in the early morning, and find myself anxious to get to it each day. That's not the way it usually works for
me when reading books.
My wife feels the same as I about religion and the Bible. That's God's grace at work with some coaching by the indwelling Holy Spirit. My lifelong depression, suicidal thoughts, and PTSD from combat in Vietnam are 90% or more erased. In spite of the increasing world warfare, societal moral decay, increasing violence, and disintegration of our government, I feel much better than I have for years. Go figure!
Topic: Where does the satisfaction in medical practice come from?
It seems to me... that I had times in my medical career when I felt satisfied, inspired, and motivated, but it was cyclic in nature, up one year and down the next. Since then I have reasoned that most of that intermittent satisfaction was the result of my circumstances and decisions at the time.
Up to the time that I made the decision to begin private medical practice I had been under the control of the medical school system, US Navy/Marines, OBG residency, and Kaiser Permanente. Although it was all exciting and interesting, I never felt fulfilled or free to make my own decisions, didn't hate it but didn't love it either. So when I cut the cord at Kaiser, it became a new world for me.
Delving into my new private medical practice in 1973 was the most inspiring time in my life. My first year I grossed about $75,000 and knew that it would get better for sure. So my family would be supported and not have to worry about going broke.
Over the next 20 years the most exciting times for me were the times that I "experimented" with my medical talents. Kaiser forbid me to do any infertility work because insurance paid nothing for that. But my interest was in doing a lot of that. I researched the literature on infertility, found no medical courses being given on that topic. For the next two years I was blessed to get many referrals of patients for infertility. No other private doctors were doing it in any serious fashion.
I began doing reparative tubal-plasties using the ENT instruments. It expanded into reanastamosis tuboplasties, reimplantation of oviducts in the uterus, and more. It was a wonderful feeling to know that what I did was helping a lot of patients that other doctors wouldn't touch. About two years later, in 1975 infertility courses came around. Other doctors took the courses and my referrals dropped off quickly.
My next peak was getting into laparoscopy procedures. I took Dr. Curt Semm's first course in America early 1980s I believe. Dr. Semm had developed and taught the laparoscopic techniques all over Europe, later in America. My associate had taken the course a few months earlier in Europe so he and I teamed up to start the new kind of surgery at our primary hospital. Then introduced it to other local hospitals. That expanded into advanced laparoscopic procedures and we were the only two in Northern California doing them early on. I became aware that my surgical talents were far more than I had anticipated. I loved doing surgery.
Following that my associate and I began the LAVH (laparoscopic assisted vaginal hysterectomies) procedures and taught it to other doctors. This surgery was safer, easier, and in demand by patients later. Then surgeons who had criticized us so much began doing laparoscopic surgery for gall bladders. They were ashamed to ask me and my associate to teach them the procedure I believe, they learned from another general surgeon who came in new to the hospital with the training.
It was rather humorous to know that the new doctor for the first two years did over 90% of gall bladder removals via laparoscopy, which made the other general surgeons angry him stealing all those cases from them. That made it important for them to learn the procedure themselves, which they did.
These were the source of my inspiration at doing new surgical procedures and teaching them to other doctors. They were the greatest source of satisfaction to me over all those years. These events gave me immediate feedback on how well I was doing in medicine, got me a lot of PR, and could never have happened during my 14 years as an employee.
Topic: Medical practice is much more complicated than in 1980--
It seems to me... after reading a large number of books about medical practice, starting a medical practice, dealing with all the many licenses and requirements, and about the business of medical practice, I have come to the conclusion that medicine must be not only the hardest career to qualify for, but also the most difficult business to start compared to what I found in 1972.
I probably today would never get into medical school, let alone be able to handle the business of medical practice requirements of today. I likely would get my medical school training in England, lots cheaper. Wouldn't it be interesting if all American medical students did their training in Europe for money reasons, and American medical schools survived financially because they had to recruit the sons and daughters from wealthy foreign families.
I knew the great advantage of having and using computers in my medical office in the mid 1980s. One day a computer dealer showed up in my office for a PC demo. I bought the whole computer package they offered for I think, $70,000 on a lease. They came to my office several times to teach my office staff how to use a PC.---first medical office in my town to get computers. They spent a small amount of time teaching me, because I was not interested as long as the staff knew how to use them.
I never learned about computers and how to use them until 1997. It took another 5 or 6 years for me to really take seriously learning computers inside and out. I missed a great opportunity in the 1980s and have regretted it since, because I probably would have gained the PC expertise at the same time that kids were learning in grade school.
Topic: How does one orient their mind to a life of constant change and unexpected incidents that force changes in their path.
It seems to me... that adapting the mind to constant and recurrent changes in a medical career, or any other career, should be a priority. It should inspire a person to become a deep thinker in order to have a knapsack full of acceptable backup alternatives. To have a brain full of experiences, is a great advantage in a world that is changing daily.
I don't think that this approach to life is very prevalent among physicians. All they really know is how to practice medicine, nothing else to rely on later. Physicians don't ever seem to have a Plan B for their careers, which makes it much more troublesome when they have to give up their private practice as so many of them do today.
Right after I started my solo medical practice, the malpractice insurance rates became so high that all the insurance carriers left California. It left thousands of medical doctors there without medical malpractice coverage... and for OBGs it was terrible. I used arbitration agreements for about two years before I could again afford to buy malpractice insurance in California. Totally unexpected.
Soon after that the mandate for managed care in medicine was passed and then we all began losing our patients to the HMOs, IPAs, and Kaiser in the 1970s. It was unexpected because most of us never understood how it would effect our own practices. You see, we though we might lose a few patients and keep all the loyal ones. It was just the opposite effect, most lost a third or half of their loyal patients and had no idea how to recruit a bunch of new patients (no business or marketing knowledge) to make up the difference.
These are reasons to train you mind for deep thinking to be successful. Get and read the book by John C. Maxwell titled, "How Successful People Think."
Topic: Professional poverty doesn't seem to bother most doctors.
It seems to me... as long as physicians can quit private medical practice anytime they choose and get a job as an employee in some healthcare organization, the issues of income will never impress any of them. Eventually when the available jobs and employment in healthcare facilities become rare, as it will be soon, then private medical practice may get more attention. Those jobs are already hard to find.
For non-specialists, jobs will likely continue to be available because there will be a continuous turnover of doctors leaving and coming into those jobs. For specialty doctors, however, job availability is now, and will become, more rare with time.
For specialists, it involves many more barriers to finding a job position. It means finding a job position that matches their choice of city or state, licensure, family desires, compatibility with peers, and being able to practice their specialty in the manner they prefer. What is so obvious a problem is that there are many restrictions when practicing under an employer of any type. Some procedures you know how to do, won't be allowed. Some ideas about patient treatment and management you may have, may be forbidden.
Forward thinking by physicians is commonly far short of adequate. Otherwise they might have made different decisions over time than they did. My experience in the military, Kaiser Permanente, and as a Hospitalist has solidified my mind about the huge disadvantages associated with being employed. Imaging leaving medical school all prepared to do great things in medical practice only to discover that you will only be permitted to do part of that expectation, because you do not control your income or your career.
What a shame it is to meet reality head-on only to discover that in medicine things are not as they seemed to be. Take the medical school teaching curriculums. These have been re-oriented to teaching medical students how to get jobs and make decisions relative to spending their medical careers in employed positions. That should logically make all medical school applicants hesitant to continue in the profession. Yet they do, because they are easily kept ignorant about what lies ahead. Students are never told the truth about what's ahead.
Topic: Could it be that what's happening to the medical profession today is just one example of many that lend strong evidence to Biblical prophesy?
It seems to me... to be all part of a growing disintegration of America as we used to know it, as well as an overall world wide economic, political, and educational deterioration of societies leading to the end of times. If in fact this might be the case, then there will come a time soon where there will be no great desire to improve anything especially in the practice of medicine.
Maybe the sustitutionary changes (doctors being replaced by mid-level medical providers rapidly and extensively) happening over the last decade or so is in reality part of the decaying process already in healthcare, at the same time that the world societies are decaying. Is it a clear and present danger that we are too distracted to realize?
Just think about it. Medicine is rapidly moving from physical diagnosis to technical diagnosis of disease. Physicians and PA's no longer ascult the lung functions through layers of clothing instead of directly on the skin. Patients are unable to afford the best medications for their health problems. Employment incomes are gradually leveling out, not keeping up with inflation. Patients can't afford nursing homes. Society survives on increasing numbers of handouts. Advanced education in now unaffordable and education is funded by ever increasing debt that will never be paid back.
All of these issues point towards one final end. Politics are unable to fix it. Religion hasn't been able to change things around. The economy blunders escalates the situation. People are becoming incapable of changing anything except by violence and destruction.
Medical schools in order to remain functional have resorted to recruiting students from many other countries, normally those who are wealthy enough to pay the tuition. Additionally, with government financial support fading and already bankrupt, medical schools now are marketing alumni for donations more than ever. A good number of the foreign doctors educated here go back to their countries to practice.
Add to that the drop in number of Americans applying to medical school should tell where medicine is headed. Then add the inability of physicians to make enough income in practice to remain solvent, at least until they become employed and then are paid in one way or another with government money that won't last either.
Why aren't doctors provided both a business and medical education? No one says that it is impossible to do, but that's what the medical education scholars think and propagate by their actions.
If all schools beginning with elementary education provided economic and business education for all students, the world would be in a much better situation. The world runs on business. All money is derived from business.
Topic: I wonder what the government will do when most private physicians choose a cash-only medical practice?
It seems to me... if private practice disappears as most are predicting, then all physicians that have become fed-up with being an employee and those who choose to control their own careers will go for the only available option left in the USA---a cash-only practice method. Then again the reality of this happening is next to none. I see two reasons for that. First, the same problems will continue to thwart the cash-only medical practices the same as they are today for one big reason... physicians aren't being provided with a formal business education and most all will fail financially. It's inevitable.
Secondly, I would expect that the government and politicians wouldn't tolerate the exodus of physicians from government medicine and legislate physicians out of their cash-only practices. You may think that you can't be forced out of a cash-only practice, but remember that the medical boards and state politicians that run them make the medical practice rules in each state. They could easily increase the requirements for state licensure, require increased CME credits, and a dozen other restrictions that would or could bring doctors to their knees again.
I believe it is inevitable that with the outrageous education debts that keep increasing with no end in sight will serve as the primary leverage for forcing all medical school graduates into employed positions. Of course, medical education in Europe and other countries is much cheaper, especially in France. One could get the doctorate there and come back to the USA and practice. Actually, it's no different than the thousands of doctors from foreign countries now practicing in the USA today. Doctors from wealthy families who can pay cash for their education are left with the best options.
The one remaining and unresolved issue today is whether the Supreme Court knocks out ObamaCare, or if the new president and congress can overhaul the healthcare system will enough to bring medicine back to a level that satisfies all the doctors.
Patient care will be neglected, the same people without health insurance will never change, and tax dollars now doled out to medical education and medical research by the government will control the whole system anyway. It's a no win system.
I have always been happy and privileged to practice in the way I chose for all those years and before I had to face the present day challenges that certainly would have made me miserable in my medical career. I never loved medicine that much!!
Topic: "American's Are No Longer Wishing to Join the Medical Profession"
It seems to me....... that I can't blame them for that. Any smart American college student should have enough brains and intellect to discern where the medical profession is headed, and it isn't good. What is quietly hidden in the recruitment of medical students are the rapidly increasing numbers of foreign students joining the profession while carrying their biases, cultural tendencies, and behavior patterns with them. That's where the money is, needed by medical schools, and wealthy foreign parents or supporters more than willing to spend what ever is needed to make it happen.
Americans are quickly becoming the minority of medical students. Who wants to become a medical professional to be forced into being an employee to survive, having their medical career determined for them, earn much less than comparable business people, lose the freedom to practice medicine as they want. The thought that a physician can't earn enough to put the kids through college, fund a good retirement plan, keep their medical office open, meet their expectations for their careers, and to live above the poverty level is a national disgrace.
So foreigners are filling the gaps along with women doctors, half of which practice part time.
At the same time the medical schools contribute directly to the frustration and disappointment of the physicians they graduate. That's because of their complete and intentional avoidance of providing a business education of physicians, whom they know will probably not financially survive in practice, which we see the results of today. Doctors are blinded to the need for business knowledge in practicing medicine, so they don't know how to run a profitable medical practice business.
At least physicians who obtain business knowledge can see the truth for what it really is. There are a truck load of reasons to correct this deficiency and a truck load of ways today to do it effectively. No one gives a damn about upgrades when they are sliding downwards more every day.
Topic: " Quashing Every Doctor's Investigative Nature"
It seems to me.......that the government controlled healthcare program, in the name of cutting medical care costs, has awakened a monster within every practicing physician's soul. This is a monster that has been unleashed to feed on the motivation and passion of every doctor's investigative mind compromising not only the quality of medical care delivered, but also the intensity of their diagnostic abilities pounded into their heads while in medical school.
I see the problem every time my wife or I see a doctor for medical issues. What I see being done is a great disregard for good physical examination, barely being examined close enough to catch any unexpected sign or symptom that could lead to a different diagnosis completely. For example, my wife had developed a chronic dry cough which persisted for months, sometimes interfering with sleep and daily activities. I listened to her lung fields but heard no rales or other pathologic signs. Finally took her to the ER when her breathing became difficult, and no cause for it.
Not only did she wait an hour to be seen by a doctor, but had to urge the doctor to listen to her chest and lungs which took maybe 20 seconds through her clothing. No lab was done. His diagnosis was "just a virus that is going around". So I asked him if the virus he was talking about was one that lasted 6 months or more without improvement. I never heard about a virus like that in my medical career. He never even considered a differential diagnosis of lung cancer in a 77 year old, allergy to something, or something related to a secondary mycoplasma infection I read about.
They knew I was a physician and hadn't brought her to the ER for a unessential or dumb medical reason---this was a significant medical problem and worsening and with no diagnostic work done to corner a tentative real diagnosis. I finally told the ER manager that if he missed a serious problem by not ordering a chest x-ray that night that they would have a malpractice suit to contend with. I was pissed.
The Internist she saw soon after --- almost exactly the same thing. For the medical care in an HMO I expected such poor care, like my three years at Kaiser Permanente where I witnesses a lot of that. It is obvious, at least to physicians who were trained 50 years ago, that the pressure to do less, spend less, and save money for the HMO was a direct influence on what doctors are coerced into doing for patients today. It sickens me what I'm seeing. I can give you about 20 more good examples of this, but you probably already see what I see as well.
Topic: "The Millionaire Physician I Met Recently"
One that beat the odds, never had a business education, and started medical practice in OBG about the same time I did.
It seems to me.......that this serves as a testimonial to the fact that an academic business education or an MBA degree is not required to make all the money you care to have... whenever you need it for something. But you have to understand that it still requires a business knowledge of a reasonable degree no matter how or where it came from. The amazing and intuitive ability he had about business building came from somewhere.
For one thing he understood that medical practice was a business right from the start. It was his daily affirmation. Even Wayne Dyer, a world renowned expert in self improvement, said, "If you change the way you look at things, the things you look at change!" And it did for my doctor friend.
He started his practice in a southern state without considering the economic and demographic effects on building a medical practice in that area. Was he just lucky? Maybe. A few times during his career he has dealt with business and marketing experts and found them to be money-sucking predators, even though he had no trouble with paying them.
I immediately knew he was highly intelligent and was the kind of self-confident person you feel like trusting from the start. I can't equate his background and family ties to the degree of wealth he created for himself. The remarkable thing to me was that he had been marketing his medical practice without knowing that he had since he started been doing it... just seemed right to him.
This doctor is an excellent exampl e of what can be done in solo medical practice when you have the right mindset for business... something that is never instilled in the minds of students by our medical education academics. The educational concept that seems to be working here is that most belief systems are formulated at an earlier age. If such people are later confronted by a new or different system that they have never been exposed to previously, rather than giving the new system your ear for a while, most outright go to and use their early beliefs and standards instead.
It's an automatic response to what seems to be a barrier that our mind creates. Therefore, most people must first be exposed to the new system for a period of time before they can recognize the value of adopting that system. And the person must be able to understand and accept what they are being taught or told about it. When these things are missing, people will naturally reject it from the start, even to the point where they tune-out the further teaching and instruction on the new system.
It's almost like having to desensitize a person to new ideas and information first, then they are ready to learn and accept. It's a matter also of decreasing a person's resistance, arrogance, and objections. The strength of these three things is different for every person. The defensive nature of most people in today's world prevents most of new and reliable information from being recognized or accepted.
This is why there are very few physicians who by the time they finish medical school have any interest, inclination, or personal desire to either recognize medicine as a business or accept the business of medical practice as a legitimate entity.
Topic: "Survival Skills for Today's Gynecologist"
It seems to me........that this being the title of an upcoming CME conference in NYC, would entice a large number of private practicing gynecologists who are feeling the sting of governmental fee restrictions and regulations. On reading the mail flyer I received about this educational event, I again discovered that their approach to helping physicians is to learn more and higher skills in gynecology that are "solidly reimbursable" elements of medical practice.
The question that immediately comes to my mind, "How is a struggling gynecologist going to have the income to afford to attend this conference, especially when it's being held at a high-priced hotel in Times Square?" I do know that I could never have afforded to attend it even at the height of my OBG medical practice years in an affluent area of the country.
The second question I have is, "Doesn't the thrust of the conference mean that to survive in the specialty one must work harder instead of smarter; maybe skinny down their practice focus to doing only those new "solidly reimbursable" procedures primarily?"
It brings up another question, "Wouldn't that narrowing down of practice focus automatically reduce the number of patients joining the practice because it would use up the time for the care of routine gyn patients forcing doctors to accept only patients needing those special procedures?" When I focused my practice on infertility patients and tubal microsurgery, patients began asking if I also did routine gynecology work.
The overwhelming and still incomprehensable inability of high-powered medical educators to recognize the real core problem of medical practice failure--lack of business knowledge and education--will remain my nightmare until I die. Instead of providing physicians with an offensive weapon (business education) they continue to provide only the defensive weapons (work harder) and they will continue to fail financially.
The obstructive nature of medical education politics, tradition, and permanently implanted and untouchable educational infrastructure continues to be the fatal bullets for private medical practice survival. The tragedy of all this is the fact that medical education scholars are too close to the profession to recognize where the real problems are for the survival of the profession.
So, I ask myself every day, "If (maybe the education scholars already know) the medical education academics are at the seat of the cause of the problem and do nothing to resolve the issue of offering or providing a business education as well to all physicians, then healthcare in our country will certainly continually degenerate in all aspects." It's not a guess, it's a prophetic reality.
Jan . 2015
Topic: "Remote Medicine May Be The Biggest Malpractice
Trap of The Century"
It seems to me........that the smart phone technology contains a significant danger to all physicians in spite of the convenience it offers to both doctor and patient. I was brought up in medicine to interact person to person with patients. If Dr. Hopkins caught us listening to the heart of the patient through a shirt or blouse, or not taking the time to specifically listen very quietly for diastolic murmurs against the skin, he would round up a patient with significant pathologic murmurs that we weren't able to hear unless the stethoscope was on the skin.
Today doctors depend on x-ray, ultrasound, and CT or MRI to make diagnoses rather than by hands on techniques. It increases the cost of healthcare, reduces the diagnostic skills we were taught, and leaves us dead in the water if those machines are not available. Once you lose your skills you become hostage to the machines.
I'm much more concerned about the misdiagnosis risks associated with relying on technology. It used to be that a man would walk into the clinic for a laceration of his leg that he got from work and during the undressing process noticed his scrotum hanging down to his knees full of small intestine. Usually men put up with the defect for long periods of time. No visits to doctors, did his own treatments, usually the old fashioned truss support my uncle wore for 20 years or so.
It had what looked like a polished wooden doorknob on each side that strapped in directly over the inguinal canals. Men rarely went to a doctor for medical problems that they could put up with and still do their job. When we as medical students found a patient like this we knew that it was a perfect opportunity for being the first "doctor" to find something else, maybe 3 or 4 other medical problems that needed treating. That puts me in mind of the test patient I was assigned to examine when taking the Part-3 of the National Board exams at Duke Univ.
I knew that if I missed an important medical problem he had, I'd flunk the Board Exam. So I examined him head to toe carefully. He had an obvious large inguinal hernia that he didn't complain about. He had several systolic and diastolic heart murmurs, and had an active melanoma on his arm. I thought I had scored well by diagnosing all three things and doubted I'd missed anything. When I listed all of the diagnoses I had made, the examiner asked me if I had done a breast exam also. The patient was about 80 and rather obese.
I told the professor that I usually don't examine men's breasts except by my manipulation while listening to the heart. The man had been admitted for breast cancer, not for any of the other problems and I had missed the breast lump completely. We discussed male breast cancer---5% occur in males---I never knew that or even thought of it. Luckily he passed me. But, I never forgot the lesson, nor the patient.
All of these things remind us that many patients have many medical or surgical problems that they never tell doctors about, hide some issues, and we only find them by physical examination of the patient. When we find them, patients are willing only then to listen to the dangers of delaying treatment, what should be done, and what is recommended.
All of the digital technology used will never come close to doing what needs to be done for patients. My concern is that doctors are becoming too trusting of remote medical tracking and monitoring. I think it is easy to get into that groove. And when fetal monitoring becomes a home process, all the OBs will run for the hills. It will be a field day for all the plaintiff attorneys.
Topic: "How Do You Inspire Or Motivate Doctors?"
It seems to me........ motivation and inspiration are quite different processes. Motivation begins and ends within ourselves. Motivation can't be given to someone or created by another person and given to you. It's created by oneself and no one else can motivate you.
You can be inspired or stimulated by others but your motivation from those processes is what your mind chooses to hear and act on. Inspiration is a process that originates either outside yourself... such as a hearing someone give a talk that got you interested in doing something... or inside our minds which was interpreted by your brain as a strong impetus to entice you to take action on something. Your motivation to go and do it is the result.
Something in your mind happens because we have emotional triggers that become activated by some sort of stimulation process such as your own ideas that suddenly surface, reasons for doing things that you hear, something that connects the puzzle pieces together and you know how to move ahead. A bridge has been created that now enables you to move from thought processes or fantasies to reality, from possible to probable, and from dreams to ultimate factual results.
How does one inspire your motivation?
Your motivation that convinced you to become a physician was self-induced and was triggered by what you thought, heard, saw, read, or understood the benefits and value of. It inspired you and then you created the motivation to do it.
Like the old saying, "You can lead a horse to water, but you can't make him drink" says that all the inspiration in the world will not incite your motivation to action unless the information fed to you convinces you that you can accomplish it.
The first step in the process is always a series of informative and convincing arguments that mentally offer you possibilities. In my view, that fact is the primary means for stimulating doctors to do anything. In real terms for example, doctors will never become motivated to attain an academic business education unless they are told or educated about how critical it is to their survival in practice. The educational stimulus is what will induce the motivation to learn business principles and strategies.
The problem today (and over the last 100 years) is that medical students and doctors are never told about, lectured to, informed of, inspired to, or offered instruction about the inherent value, benefits, advantages, and responsibilities they have to learn business essentials. All this is entirely forgotten, disregarded, or left out of the medical education process.
Isn't private or group medical practice a real business?
Shouldn't physicians be taught about running a business profitably?
What happens when a person runs a business without any real
Why do you think so many physicians are now selling their
practices to hospitals?
How can a physician improve their income other than by working
harder and seeing many more patients ending in burnout?
What is the one simple way to insure every physician will not lose their medical
practice for financial reasons?
If your mind is in need of some additional clarity about business knowledge in
Read my new book being published and distributed this month at all the usual book vendors, Amazon, Barnes and Noble, etc.
Title: The Wounded Physician Project
I think you will be amazed at what you learn!
Topic: "Following the trends of doctor employment in the media may change your mind about being an employed physician in an unstable career."
It seems to me... there continues to be an increasing number of subtle warnings about the unsettled and threatened cut back on physician employment across the board. Consider these issues....
1. Legal actions against nursing homes has increased exponentially. Patient neglect, abuse, and medical treatment are the focus. Doctors who are involved with nursing homes are always included in the legal actions. (WSJ article 10-4-14 by
2. More patients are flooding Medicaid programs to the point that there is a shortage of doctors to treat them properly. Funding levels for Medicaid have been level for several years now and fee restrictions continue to rise. Don't you see what eventually happens down the line? ---no doctors can afford to see and treat these patients---so reliance on mid-level providers will do the job, and healthcare worsens. (WSJ article 11-14-14 by Louise Radnofsky)
3. Increasing hospital debts from increasing uninsured patient healthcare now face the upcoming cuts in federal funds that help reimburse hospitals for doing this. So how do you fix this... certainly not using Obamacare, government in bankruptcy, antigrowth policies, and still have 25 million uninsured the same as we had before Obamacare (ACA). Hospitals must reduce costs soon. They do it fast by firing high-paid employees such as doctors, admin. nurses, and administrators first. (WSJ article 11-12-14 by Anna Wilde Mathews)
4. Valeant Pharmaceuticals is now begging the help of cosmetic surgeons in an effort to buy Allergan, maker of Botox. Another incident where doctors are more important in medical industries, politics, and building financial relationships with physicians. Valeant is paying physicians consulting fees of around $30,0000 with all the fringes. (WSJ article 11-13-14 by Jonathan Rockoff)
5. Accountable Care Organizations (ACOs) have been touted as HMOs, but with more power---since HMOs have not significantly reduced healthcare costs, the ACOs have taken over thinking they can do it better. For reducing healthcare costs the ACOs collect the excess money from bundling care for a fixed price. You and I know that won't happen if healthcare remains good, only if the quality of care decreases. (WSJ opinions 10-31-14)
6. Borders of healthcare are becoming faded. Battles are increasing about licensure for various kinds of medical care, like teeth-whitening procedures vs. Dentists. The invasion of usual medical care is progressing rapidly by unlicensed non-doctors. Doctors may be able to earn more joining that group than in regular medical practice. It's a good startup idea for doctors leaving an employed position.
The November election is over and the country has two more years yet before any of the alterations in the healthcare issues can be implemented, assuming there will be any. Physicians will remain in complete uncertainty about the sustainability of private medical practice, unfortunately. The expectation of continuous changes doctors face in medical practice is something that will be remain a powerful driving force for preventing the growth of medical practices and cause for attrition of physicians.
The age of employed physicians is just beginning and I expect that the continued educational debt of medical students will force them into an employed life from now on.
Topic: "Pro and con of remaining in private
It seems to me........ as I look at the survival problem for the remaining physicians in private medical practice (about 50%), you will always have the upper hand for managing your medical careers and how you practice medicine. I think better by listing the pros and cons of each, and it may offer you some ideas to work on.
1. You are your own boss, in total control of your career, level of success, level of income.
2. You have the choice of determining the
money/income you need and want to match your personal/family financial obligations and lifestyle.
3. Your career expectations are unlimited. Since you control your medical practice productivity, you have the opportunity to modify any necessary elements of your practice to meet your expectations.
4. When you are motivated to accomplish your goals for your medical career that you desire, you can do it... but requires much more work than you expected.
5. You have the opportunity to practice medicine anywhere you desire, with few exceptions.
6. Learning the medical statutes, laws, and practice-inhibiting factors are important for you to start practice is a state that offers you the greatest advantages for your success and for your complete satisfaction in medical practice.
7. Because you are a medical professional and are in full control of your career/practice, you have the advantage anytime of moving your practice, cutting out practice elements you don't want to do anymore, gaining new skills and knowledge to expand your practice income and enjoyment, and choosing partners, associates, and employees.
8. You are in control of your retirement plan, funding your children's college education, and determining the lifestyle you want.
1. The level of control of your medical practice, career, income, and success is dependent on the extent and use of your business knowledge and skills outside of your medical skills and practice.
2. Your choice is strongly modified by the passion, efforts, and self-discipline you maintain career-long to to meet your expectations. No one there to prod you other than yourself.
3. How much you are able to modify your practice to meet your expectations is dependent on your level of income that allows you to make those alterations you need to reach your expectations.
4. The clear trend among the great majority of private practicing physicians is to alter their goals to much lower goals, because they don't earn enough income to reach them. Doctor's being business ignorant have no idea how to avoid this problem.
5. If you don't begin your practice in the area where your best potential exists for your success, you will be forced to live in a lower middle class existence for lack of income to do any better.
6. Many states curb your practice activities more than others. Malpractice risks and protection, abortion laws, licensure problems, and levels of practice are elements that vary widely from state to state.
7. Practice goes well when you are continuing to practice, but the income stops when you are disabled from any cause, become legally convicted, have significant health problems, etc. Some will help you but no one will run your practice for you.
8. About a third of medical doctors retire from practice without any retirement plan. Another third have a retirement plan that will not support their retirement needs and wants. My estimation is that almost half of physicians can't fully fund the college education of their kids. Education scholarships, grants, education loans are often hard to obtain because of your professional status. Students either must attend a less expensive college or not attend the college they desire... or forget college.
1. You have relatively stable employment and benefits. The business side of medical practice is taken care of for you.
2. Usually salaries are reasonable or somewhat better than private doctors in the same specialty as of November 2014.
3. What you practice and how your practice in your employment is limited to the common usual standard practice of your specialty. All of the easy extra things you would do for patients in private practice are unnecessary. But you do have to measure up to seeing the same number of patients as the other doctors.
4. Your medical education is paid for, so it's a good idea to obtain all the extra training you are interested in practicing while you have it all paid for (You might quit later and could use it later in private practice).
5. Hospital and HMO physician employees have access to immediate consultations in other specialties who are in the same building or nearby.
6. All patient appointments are made for you... which are prescheduled solid for up to 3 months ahead.
7. Time away from the job is easily covered by the other doctors, but conferences, workshops, and vacations have to be scheduled far ahead.
8. Comradery is most commonly with the mid-level healthcare providers rather than your peers.
9. Most physician employees are very good physicians and well trained.
1. Job stability is fragile. You can be fired any day, or your contract will not be renewed for many reasons.
2. As Obamacare continues and the economy does not improve, salaries are expected to drop, the most highly paid people will be let go to compensate for dropping income of employer.
3. You are expected to practice in a way that offers the most profit for the employers. Infertility work, psychiatry, and a few other medical practice elements are poor producers of good income and are not usually covered by health insurance... so are often forbidden or restricted to clinic schedules.
4. There is little incentive to gain new skills, do your best medical care, gain greater knowledge, because doing so does not usually result in increased salary or benefits.
5. These employers are strict about terf battles. OBG physicians who are fully trained and excel in OBG sonography, for example, may be forbidden to do sonography themselves, even when no charge is made for the procedure, and done to make quick diagnosis in their patients... because radiologists would be denied the income from that procedure which they claim as their terf only.
6. Special procedures, fit in appointments, and quick return appointments are almost impossible for you or the patient to make.
7. Seniority determines who gets first choice of time off for anything.
8. Social life is more often outside the employer's and employee peer relationships contrary to that of private practice.
9. There are also a higher percentage of borderline competent doctors found in employed physicians than in private practice. The reason is that they can survive only when connected with other doctors close to them to help them along.
There are many other pro's and con's as you might imagine. These mentioned above are a summation of the issues I confronted in my 6 years in the military service, 3 years with an HMO, and 5 years of hospital employment. There are an earful of other issues that make or break physicians practicing in any type of circumstances.
You will likely make most of your decisions about medical practice based on your emotions, personality traits, connections, and interests rather than business facts, unfortunately.
Topic: "Can Physicians Actually Over-learn And
Over-load Their Brains"?
It seems to me........ the question is unanswerable unless one defines the storage vacancy limits of the brain and then creates measurement scalability of the information consumed. And who can do that? One thing is certain, that anyone can reach a point of burnout, confusion, loss of focus, and lack of analytic ability that creates shutdown of acceptable brain function leaving a person without passion, energy, ambition, and abilities to recover a great deal of what they have lost.
Prevention of that is a matter of balancing one's life between their work and family/social environments. Frequent periods of time-outs with complete escape or distraction from the work efforts is commonly advised. When a doctor doesn't know how to implement that pattern into their work passions, things fall apart, like marriage, social life, and career maintenance. All these problems commonly are denied, deferred, or left to fate unless a good deal of self-discipline is present.
Because physicians are so vulnerable to these problems and many others and because medical students and doctors are offered no emotional or mental support during education and training, all physicians are left to their own control and consequences. Some of the law schools have begun mental counseling of law students because of the increasing numbers of suicides and depressive episodes of attorneys. I became so depressed after flunking a major medical course in medical school, thinking I would be kicked out of medical school as a result, that I considered suicide at the time. It would have been a complete and intolerable event to be booted out of med school after such a long and hard toil to get there. There was no one there to counsel me I believed, at least there was never a mention by faculty that there was a place for students to go for help in 1959. After a talk with the dean, I found that there were 50 or so of us who flunked the test and he had no reason to send them all home for that single event.
Three days later I was back to normal again.
It's worth talking about today because medical students are pushed to learn much more in medicine than when I attended medical school. There is a limit to what any student can tolerate although it is different for each student or doctor. What I see happening is that medical students are being given medical courses that are later never used in real medical practice for 95% of students. That's wasted time in life, learning, and medicine. Since business is the foundation for a successful medical practice, it is logical and common sense to teach business during medical school in place of those useless medical courses.
There is no doubt that the business of medical practice is just as important as medical knowledge for private practice doctors. Business knowledge is also important to doctors who are employed, quit, and start medical practice (about 14%). Why are physicians quitting medicine in droves, selling their practices to hospitals, and so frustrated with their careers today? They are discovering that when you can't earn enough money to stay in practice and meet your family obligations, their careers are in jeopardy. They have no idea how to run a medical practice business successfully, nor how to effectively increase their income at any time they need to because they have no business education that would give them the skills, the knowledge, and strategies all businesses use for success.
If you want at least a fighting chance to accumulate enough business education to enlighten you about the value that info has to your career and enable you to get started using such business knowledge, then by reading all my articles on this website and the books I keep recommending to you you would be much farther ahead in your career than you will be without it. If you don't believe that, then it's a choice you have to live with during your career in medicine. However, you can always become employed and make money for someone else.
Jan.2014 to july 2014
No Medical Practice Insights while I was writing my book.
Medical Practice Insights - 2013
December 11, 2013
To my interested newsletter subscribers:
RE: Notice to all my subscribers to “Marketing A Medical Practice Ezine
Business and Marketing Magazine” regarding discontinuing this free informational and teaching publication.
My decision to discontinue the publication wasn’t easy in light of my continued passion
to do something significant about preventing the ongoing tragedy of medical doctors and
other professional healthcare providers losing their practices in increasing numbers for
In my view, it’s an unforgivable neglect of our educational system not to have provided a business education, even the basics, for professional healthcare providers during their
training process. It would have provided a major force in preventing the tragedy of doctors losing medical practices for financial reasons.
The medical education system in all medical schools is so embedded with tradition in the
minds of the educational elite that any improvements in the system will never go beyond
trying to stuff increasing amounts of medical information into the minds of students, most
of which will never be used during their medical careers.
It leaves no room or time, it seems, to provide a business course, whether voluntary or |required, by any method, to whatever extent or to whatever depth of knowledge that’s reasonable, which any mentally capable person could construct and teach in a period of
months, not years.
If the money was available, I could do that quickly and efficiently, but I found myself looking
at this well hidden medical education story as a real-life victim of the lack of a business education during my private practice years.
This is a love-hate relationship with medicine today which I’m sure all doctors feel more seriously about every day that passes.
My reasons for quitting the publication are...
(If you are one of the 2% who even open my emails)
Abundantly clear, is the reality of the advice I received from a dear millionaire business friend over 8 years ago. His advice was to take my passion somewhere else than to try to alter the fixed medical minds of those in control of the medical education system. And that I ignored.
My thought was that I, as a member of the medical profession, an insider, might be in a
position to be recognized and considered to be a legitimate resource for improvement of the medical education system. After 6 years of effort, it’s evident I’m not.
Secondly, he told me what his ultimate business-life had taught him. He explained it like this:
“There is a profound conflict with and undermining of what they sell —the idea that being a doctor puts you above such grubby dealings and concerns, and conflict with the knowledge base and mindset of everyone in control of these institutions”.
“What they sell” means their “product” in their minds that they sell to all who will listen, is
to provide a reasonable medical education and training, nothing else.
Over the past 5 years, I’ve discovered he was right in all aspects. And so I’m changing paths
for my own benefit. I will be leaving my website www.marketingamedicalpractice.com online and may add some materials to it from time to time.
It means in reality that the hierarchy of individuals who establish the criteria for all medical schools to follow, at least at a minimum level, are entirely focused on providing only a medical education and training. What is totally disregarded by those authoritative individuals is what is screaming to be recognized and implemented.
That issue is about their responsibility as educators. They certainly know that medical practice
is a business the same as dentistry and the legal profession. The missing parts to the
education obligations are not only to prepare doctors to have the knowledge and skills to be good healthcare providers, but also to enable these professionals in a business to at
To become the highest quality physicians providing healthcare and serving their patients, maintaining a financially solvent practice in that business requires a business education. Otherwise, 100% of doctors today will all fail to some degree. They will continue to fail because medical schools have already decided among themselves not to provide a business
Can you imagine how the medical profession would be elevated to it’s highest efficiency and productivity if every doctor provided with a business education started a private practice
fully armed with the business survival tools.
Think about this professional productivity sequence
- Everything we do requires money.
- The more money you have the more things you can do and accomplish.
- To make money in a business, you have to know how to run a business successfully.
- By implementing and using the proven criteria for success that every successful
business owner understands, all business owners have no limit to the amount of
income they can reach.
- Physicians and other professional healthcare providers with a business education earn
the most income by far among doctors, with few exceptions.
- Physicians with a business education and in private medical practice use their
discretionary money to improve their skills, knowledge, and self-reliance.
- Physicians with enough income are more skilled and have more knowledge than those
who don’t have a business education nor money to improve their skills and knowledge.
- Physicians with a business knowledge, more skills, more knowledge, are much more valuable to the medical profession and their patients than those who don’t.
- Physicians with the better incomes expanded by using their business knowledge are
rarely dissatisfied with their profession and are able to fund retirement plans, pay for
their children to get higher education, and life a lifestyle commensurate with their professional status.
10. Professional income is the single most critical issue today
that influences and controls the potential and capabilities of
every physician in private practice today…..absolutely!
My intention is to focus on only medical students who need to learn these things while yet
in school and while they may not have yet closed their minds to the common sense about learning business principles one way or another.
These are a few of the issues that cripple anyone publishing any newsletter today...
- The open rates for subscribers who take time in this busy world to pay
attention to those who try to help them is well under 10%. Yes, skepticism,
bad information, need for instant and easy solutions to problems, and the lack of
diligence are responsible for a lot of it.
- Feedback is nill... Over the last 5 years, I have had less than 10 responses to my “newsletter and educational efforts”, in spite of continuous requests for feedback.
Either no one cares about the issues published, what they’ve been told or taught, or
are in “give-up mode” in life, or they have a fixed mindset impossible to penetrate.
- My ignorance... It may be that I have focused on the wrong topics, materials to help, presentation tactics, poor writing ability, wrong audience, or many other factors that
are not needed.
- Truthfulness is outdated... Apparently the only approach that works is that of entertainment, video, specific interests with a niche audience, and coloring all the
negative aspects in life with stories that turn out well, creating hope when there is
none in reality, and telling all what they want to hear.
- Having money gets it all... You can do nothing without money, adequate money,
extra money, discretionary money, saved money, flow of money. I have none of these
for more than basic living.
I never asked you to subscribe to a paid newsletter, for even $20 per month cost. However,
with a minimum number of subscribers opening my emails, I doubt I would have retained any subscribers at all, an indication that my information and advice was not of importance. I was most likely wrong again about that issue also.
My intention is to focus on what medical issues people are interested in knowing about, write eBooks on them, and make some money with that effort—maybe. There’s lots of money out there, you just have to find a way to get some of it, even when you are a medical professional and run a medical practice business that’s going downhill.
What I have been pleased about are those of you who have remained subscribers over the
years, so I must have touched your mind somewhere along the line.
Only in the last few years have a few books appeared on the market written to help doctors
and healthcare professionals avoid problems in their medical careers, some great, and some poor. Most of those books I’ve found superficial in the marketing and business information
and advice, unfortunately.
My intention is to do coaching of new doctors and medical students. Maybe the one-on-one
with the personal interaction will turn out to be lucrative and fulfilling for me eventually.
One last comment may seem unusual to you because it’s a personal business concept I’ve reached and want to write about.
Topic: “Teaching Kids business and marketing from about 5 years of age upwards”
It’s about the only way kids will be able to go to college and/or survive in the future. It’s
more important and beneficial than learning science or math in my opinion.
Wish you well in the future,
Curt Graham, M.D.
P.S. Feel free to contact me anytime---my mind is still open and functional.
P.P.S. Would you please fill out the survey below for the purpose of encouraging me to continue the newsletter I send to you. If you have used my ideas, you probably have
benefited financially in your business by thousands of dollars---all for free.
Copy and paste this survey and answers into your email and send back to me with
“SURVEY THOUGHTS” in the subject line.
- Continue this newsletter, or not?
Would you be willing to pay even $10 dollars a month for it?
- Has the newsletter been of value to you?
- Five issues I need to have you discuss with me:
- Name 5 factors that you recommend that I do to benefit you:
- Other comments about the newsletter:
Thank you kindly-----
Topic: "Destiny of American Healthcare"
It seems to me........ if you kill off all the present physicians with medical practice restrictions
and outside government controls, then who would become physicians except for martyrs.
Topic: "The lost generation struggles."
It seems to me........ like there is the beginning of some semblance of an awakening to what I
have had on my mind and published on my websites for several years. Over the last few months
I have read dozens of media articles on such things as decrease of college applications, struggles
of a lost generation, the need for a major effort of the universities to start entrepreneurship
courses and career programs, and the rise of startup businesses in the USA.
Our kids need to be educated in business principles and strategies at a much earlier age, how to be entrepreneurs instead of employees in a world that no longer provides the stability of income, jobs, and retirement we used to have, and the need to provide a realistic path for financial independence
of our young people. The importance of teaching them how to do it and make their own way in life with much less dependence on family, industry, employment, and government tax based resources.
Even more important, this lost generation of our young people I believe can be taught and given a chance to become creative individuals well beyond what they are today.
They have to be educated in business interactions, then creativeness, then entrepreneurship, and finally how to discover their own talents, skills, and interests in order to put all that education to
work on a path that provides personal happiness, fulfillment, and prosperity. This sequence may
eem backwards, but I am always reminded of so many people, including myself, that select goals
and careers that offer little more than survival. And that's because their choices are made before
they are educationally prepared to envision the end game of the maximum potential of
So, here I am with these, what I believe to be, fantastic thoughts and earth shaking ways to help
our world to advance far beyond our present human potential. All that has been sidetracked by so many distractions that never leave time for introspective thought. I have no illusions about any of these ideas ever being brought to reality within our society because of our loss of thoughtful leadership, unbelievable corruption of those in control, and the unwillingness of those who can
change it for the better to step up to make a positive difference when sacrifices are of little value
to the majority.
Wow---I think I just fell off the deep end here. Anyway, I do believe that with the active forces opposing the will of God so fiercely today and the efficient elimination of Biblical principles from
our society in continuing and increasing fashion, leaves us facing the end that has been prophesied
for over 2000 years. We started out on the right path, but failed to stay on the high road as
time went on.
It's certainly clear that life's real rewards lie not on this earth at least in this dimension.
P.S. College education is neither a requirement or necessity for success and happiness. But it's
helpful to get to that level faster.
Topic: "Things I would do differently if I started over in my medical practice and
It seems to me........there's not enough due diligence paid by new medical students and young doctors to try to understand and make use of the connections between choosing the right specialty
to become master of and the profound reality it holds for the career life of any doctor.
The praiseworthy choice to become a general practitioner results in a career life of low income, personal family frugality, and persistent tolerance for living and practicing with those results. As I
see that choice it's a medical career that offers few monetary rewards and a truckload of fulfillment. There's nothing wrong with the choice except that it involves a sacrifice of lifestyle, family
necessities, ultimately of a doctor's full medical career potential, and sometimes the marriage and family. It seems to me to be a very selfish decision.
Knowing what I know, feel, and think about my medical career today, starting over I would choose
a high earning specialty like plastic surgery, orthopedics, anesthesiology, or invasive cardiology. Avoiding the high malpractice risk specialties would be an absolute certainty--like OBG. Hell, let
the CNM's (Certified Nurse Midwives) do that work as much as possible because they are rarely
sued, and most are well trained. Malpractice insurance increases makes the specialty almost masochistic in nature.
I would likely choose a midwest city to practice in (net income best in country) that contains a
college or university, around 500,000 to a million people, year round nice weather or reasonable weather, and near good recreational areas. In present day medicine I would join a single specialty group where call coverage and time off can be easily managed. A single specialty association of several private practice doctors would be acceptable, especially if bad interactions among the
doctors necessitated moving my practice.
I would right after specialty training obtain at least 4 to 6 state medical licenses and maintain
them in active status long term. That's because of the increasing numbers of doctors moving elsewhere for a bundle of valid reasons during their medical careers. I expect there will be a significant increase in numbers of doctors changing their situations in the future.
As much as I loved medical practice during my career, it is certain that I would not ever enter
the medical profession again for many reasons.
Topic: "I wonder what percent of physicians would double or triple their income if they
knew and applied the laws of influence, attraction, charisma, and negotiation in
It seems to me........based on the books on these topics that I read and learn from one after the
other that most physicians have no idea how critical these behavior patterns are to building a
medical practice. I never knew they existed, let alone what value they might of had in my medical practice income and growth. It's just another chink in our armor we never learned in college or
Now that I have a very clear understanding of these laws and their power and the fact that we use
all of these factors throughout our daily lives to some degree without even recognizing we are doing
so, it is easy to see that any success we find is directly dependent on persuasion. Success is also dependent on interacting and getting along with other people, getting them to listen to you, do
what you want them to do for you, and getting them to agree with you or your ideas.
When all of these influence factors are learned, practiced, and used frequently, they enable you to become more successful, earn a higher income, are trusted more, and gain a much higher position
in your job or career. All these laws added together creates charisma. People are drawn to you, trust
you automatically, want to associate with you, and are eager to listen to what you say... that's
charisma. You've probably been in a group event when someone walks in who immediately attracts
others without doing a single thing to make it happen.
Nearly all high level business people got there by using the laws of persuasion one way or another. Physicians can learn these principles of behavior and use them to advantage in dealing with patients.
My article this month discusses all this in detail.
The best book about these things that I have found and recommend you read is
MAXIMUM INFLUENCE , by Kurt Mortensen. His other book, Laws of Charisma is just as
valuable for any doctor to read. You'll be surprised about how much you have missed and could have used in your medical practice.
Topic: "Tell Me I'm Nuts!"
It seems to me..........that I've placed myself between a rock and a hard place. I'm nearing the
end of my article series about "Why Doctors Fail" and I, as many writers often do, catch a passing
thought about one of the rules of writing----Readers just don't like to read negative creatives and
topics slanted in a negative direction. However, when most all descriptions about important issues
are painted in a positive stream, it seems that readers walk away with a silly grin. Probably that's because they are thinking they were able to avoid any written implications that the reader
interprets as mirroring themselves.
Most readers recognize that all issues aren't as pretty and positive as described. There's a downside
to about everything which often is a reminder that something can be done to turn negatives into positives. If the negativity points out the areas of thinking, action, and responsibilities that need improvement. In medical practice today there is a great need for physicians and other healthcare professionals to seek ways to combat the increasing pressures and deterrents that threaten your
Even the worst punitive criticism about one's own potential failures can be presented in a manner
that is not only constructive, but also profitable in nature. This is what is behind my series of articles about why and how doctors fail themselves in so many ways that they don't recognize. My contention
is that someone has to point out these frailties to them and inspire doctors to move up and ahead
beyond what they think they can handle.
The evidence easily visible today tells us that the majority of physicians are barely able to maintain
a mediocre medical practice for many reasons. This is exactly the opposite of the circumstances of
medical practice 50 years ago. Because I watched my practice disintegrate in front of my eyes as a
result of these changes, not knowing how to rescue it, I understand the extreme frustration most
doctors feel today.
And, because I had to find out why I failed, and did. I now know and understand most of the
deficiencies that persist today that continue to destroy doctors in private medical practice.
My series of articles about this issue of medical practice failure, in my view, necessitates irritating
doctors who read what I write as a means to push them to recognize their own shortfalls and what
to do about them. I don't write to ridicule, to distract from the excellent work doctors are already
doing practicing medicine, to find fault, or to cast suspicion on your capabilities.
Every physician is capable of doing, improving, growing, learning, and deciding that they can do considerably more in their medical practice business part of practice than they are doing today.
The problem is that the knowledge about how to do it is sorely lacking. The cure for this problem for most doctors is obtaining a sound business knowledge which I have been trying to make them
aware of over the past 8 years.
One of the misleading aspects of most programs available for improving and streamlining medical practice business for better efficiency and income is that upgrading office business procedures, equipment, and software sold to you will not resolve the real causative factors that lead to medical practice financial failure.
The resolution of the practice failure problem is actually only a single process, the critical thing. Until physicians correct the gap in business knowledge that is absolutely necessary, medical practice financial failure will continue indefinitely. I guarantee that.
Oddly enough, a similar type issue of brick-walled efforts is now toppling our own government.
Topic: "Where is medical education headed?"
It seems to me... that the future of medical education today has to require seriously planning for
what is being required of medical doctors in the very near future. I'm referring here to the rapidly increasing percentages of graduating medical students who because of their overwhelming
educational debt or because of the new generation of medical students who don't want or need to
work hard for much of anything, are choosing to become employed physicians. The AMA Survey
recently reported that at least 50% of students are choosing that route to practice medicine.
If private practice, as predicted, disappears in the next few years, then all medical students will of necessity have to be taught and trained how to survive as an employed doctor. Should that be the
case, it's logical that medical schools will become easier and less stressful for students since all
medical students will be doing the same thing in practice--having limited practice and
independence as an employee.
Probably, medical education will follow the highly promoted concept today of "Team Health Care" in
the future. That's where patient treatment becomes a matter of committee decisions exactly as
corrupt as we see daily in our government decisions. It reminds me of the description of a
"committee." ..... where a committee project is to create a horse, which in the end results in a
camel. Committees have a hard time agreeing on anything.
Up to now, private doctors have had the advantage of using every element of medical education,
training, experience and expertise to give their own patients the best form of treatment they know
to give a patient. When that means of treating patients converts to a "team/committee" decision
process (where each member always seems to have a better idea or different way to treat the
medical problem), the medical treatment options widen, but are not any more reliable than the
patient's doctor would have done anyway.
The supposition that team efforts are better for a patient than what the patient's own doctor would
have done, has not been proven to be better by double blind or other studies.
Supposedly, that "instant education" by the committee process fills in all the essential gaps in the medical knowledge that's necessary to provide the patient with even better healthcare or treatment,
may be a myth.
Of course, in healthcare you can't possibly know everything so there is a concept that using a
committee to decide the best care incorporates the knowledge of many members in order to reach
a better treatment than you can do yourself. And, if that's true and reliable, then why not put every patient treatment decision in front of all the medical staff members where a more complete
knowledge base exists, and therefore much better treatment results?
Then there's the fact that many members of that committee won't even be medical doctors, but yet
can influence the decision making without having all that medical experience and knowledge. The
most efficient and reliable form of control is a dictatorship. So, who is the head of the committee
and does that person make the final decision?
How does a medical school curriculum teach a student to handle the peer pressure, intimidation and coercion present during any committee decision making process. As an employee, a physician must
be adaptable to what the decision makers want them to do. That factor means that the student or
young doctor doesn't have to be medically smart, just learn the easy and common medical stuff and
the rest will be decided by the "team". I call that "welfare practice"............treatment is derived
from the entitlements of the team.
Our society and culture has been educating all of us to get a job. Meaning that we are all being
educated to be employees, not independent thinkers or entrepreneurs.
Medical education will have to shift their curriculums to teach doctors how to handle medical
employment and how to handle being restricted from using all their medical knowledge. So, they
would not need to be taught a lot of medical stuff they will never use during their employment.
Maybe that would reduce medical school to less than 4 years as well.
Somehow all this seems to be point towards college educational systems that have succeeded over
the years in convincing premed students that the "getting a job" goal is of primary importance to
them. It follows that these students enter medical school already mentally predetermined to seekemployment as a physician rather than private practice. It drives the herd to follow the leader
until all doctors seek the same employment attraction. Couple that with the new generation of
doctors who also prefer an easier way to practice medicine, to practice part time, or to consider
medical practice a hobby to do now and then.
Add to those factors the fact that 50% of female doctors that occupy 50% of each med school class practice medicine only part time. Part time practice usually requires being employed in one
fashion or another.
Do you think that medical education must conform to whatever kind of medical practice is available
to graduating medical students, such as being employees only?
Or, do you believe that medical education will not change, regardless of who controls the practice
of medicine and methods of healthcare in the future?
These are thoughts that run through my mind often. It bothers me because I will soon be the recipient of future healthcare and I dread the thought that my care or my family's care will be
managed by part time doctors, lazy 9 to 5 physicians, or by team decisions that I consider
unreliable and infected with mixed biases and opinions.
Topic: "The Problem of Taking Time To Think"
"Thinking is the hardest work there is, which is
probably the reason so few engage in it." ---Henry Ford
It seems to me.......... that it took me a lot of years to learn how to think, today at 75 I believe
I'm possibly the best thinker this side of the Mississippi......or not. At least I practice the process
a lot more now than I used to.
I remember Mr. Rose and his son that I hired as carpenters to build another room on to our house.
He was referred to me by a friend along with very credible credentials. As he worked on the
foundation and wall construction, I noticed I would find him fairly often sitting on a pile of 2x4s
quietly pondering something. He wasn't on an hourly pay setup where I might have believed he
was wasting my time and money, but I was in a hurry to see the job finished.
So one evening he was still working when I got home, the perfect opportunity to ask him why he
spent a good deal of time sitting by himself quietly. I knew it wasn't a health problem by his
sturdiness and carefulness he used in his work. His answer was probably the first time in my life
that anyone had made me so enlightened about thinking. He told me that everyone in life should
take quiet time to do thinking about most anything.
His explanation to me indicated that he used thinking to make decisions about my room
construction, organize what should be done first, or next, and the reasons for it so that time would
not be wasted doing over all the mistakes that one fairly often made in construction. It also avoided having to throw away a lot of good lumber and materials wasted in those blunders---let alone the increased cost of materials that resulted from that.
I realized he was trying to carefully get the job done faster and with less cost to me, thinking of me
and not himself I suspect. The idea has remained in my mind for all these years. It brings to mind
how much time physicians waste by not spending time thinking. I remember all the times I had to
wait in the surgery doctor's lounge for my case to begin because of delays by the cases ahead of me
on the schedule. Actually, I never saw a doctor reading a medical book or journal, or managing
practice problems on the phones
while waiting, including myself. Waiting sometimes was far more than an hour.
The same was the case as I waited on a labor patient to progress along. That wait time often went for hours and hours, which some doctors used to go back to their offices to do work there. But, there are more important issues here. In such a busy and rapidly advancing world we take even less time for thinking through issues and problems, and therefore make more mistakes in our practices.
If you had asked me what was happening in the outside world in those years in practice, I doubt I
would have known. In the early 1970's I didn't see what was happening in medical practice like the
fact that managed carehad been approved by congress and was in full swing. When I saw my good patients disappearing to the HMOs, my income dropping, and having to sign hundreds of participation contracts with the HMOs, at lower fees, to keep at least some of my patients, I finally got serious
about thinking where I was going and what I could do---late---but did it.
If I had taken time to think, and kept in touch with the happenings and news, I would have saved
myself a lot of grief. But, I was so busy seeing patients, the thought never entered my mind... a complete distraction by my "busyness."
"In solitude the mind gains strength and learns to lean upon itself."---Laurence Sterne
The same thing happened to me when suddenly all the medical malpractice insurance companies left California. If I had been thinking and watching, I would have seen this coming down the road.
Instead, I went "bare" for two years until the doctors finally started their own medical malpractice insurance organizations and got on board. I even thought of quitting OB at the time because of the inherent risk of the specialty.
Lesson: Any medical doctor that doesn't take quiet time thinking about the eventual effects things
that can and will demand changes in how they practice, is likely to always be reacting to their environment instead of being proactive. Unfortunately, their destiny will be determined by
circumstances and events, not by personal choice and control.
It's always interesting to me how we travel through premed, medical school, internship and
residency with the power of our discernment, diligence, and decision making, yet suddenly stop
using those attributes during private medical practice. Your life as an employee means you will
always be working for the rich, and all the rest is done for you by someone else, usually by
someone who is not a physician and doesn't think like a physician.
And that, doctor, is an absolute medical career tragedy that keeps trimming down our professional potential and capabilities, crippling our freedom to practice medicine the way we see that best accommodates our personal desires, satisfaction, fulfillment, and happiness in our lives.
Topic: "The Games Are Over, Lick Your Wounds, Protect Your Family"
It seems to me.......... we are so consumed by the agenda of the Liberals/Progressives that I believe
in 5 years our nation will be in shambles, enough so that the medical profession as we know it will
be a memory. Our nation is unrecoverable at this stage. By the time Obama has completed his
massacre of capitalism over the next several years, every doctor will be forced into the existent Obamacare system of healthcare, and no such thing as private practice in any form will be permitted.
The democrats have locked up the control of our country, economy, judicial system, and government
so tightly today that only riots and anarchy will be able to change the downward fall. I say that so emphatically because I have been diligent in my reading, research, and reasoning to the point of confirming in my mind we are in that much trouble.
Congress is deadlocked and can't be changed. The increasing entitlements will guarantee that because
of the voting influence of the recipients of government handouts who will overwhelmingly vote into office those who will continue the handouts that they have not earned. It won't be long before doctors
are forced to accept all entitlement patients whether you want to or not. Physicians income, salaries,
and lifestyle will be driven downwards like never before---and the silly part is that it already is happening.
The complacent attitudes and optimistic jabberings are a smokescreen covering up the true political agenda now visible to anyone who seeks the truth. People like the generic economist who writes for
the New York Times, Paul Krugman, are saturating the media with demagoguery in an effort to
convince everyone that socialism is good for everyone. And, that inflation, printing up more paper
money while decreasing the value of real paper money, is the means to diversify the wealth... take
from the rich and give to the poor.
It seems clear that this battle between socialism and capitalism has been going on for centuries.
Three hundred years ago Emanuel Swedenborg wrote, "It is no proof of man's understanding to be
able to affirm whatever he pleases; but to be able to discern that what is true is true, and that what
is false is false---this is the mark and character of intelligence." Democracy will cease to exist when
you take away from those who are willing to work and give to those who would not (Thomas Jefferson).
The socialist leader, Norman Thomas, said, "The American people will never knowingly adopt
socialism, but under the name of liberalism, they will adopt every fragment of the socialist program
until one day America will be a socialist nation without ever knowing
how it happened."
Great economists such as Ludwig von Mises (1881-1973), Hans Sennholz, Kurt Richebacher, Irving Fisher, as well as financial geniuses such as Robert Ardrey, Peter Drucker, Leonard Read, Graham Summers, Andrew Dickson White, Brescioni-Turrroni, Henry Hazlitt, among others have witnessed
and written about the tragic results of the publication written by John Maynard Keynes', "General
Theory of Employment, Interest and Money." Keynes provided the rationalizations necessary for politicians and government to spend and inflate money endlessly. Our collapse is a certainty.
Cuba is a good example of the philosophy of Keynes. Socialism masquerades as social justice by rewarding people for reasons other than hard work and diligence. The problem in our own nation is
the same. Author Richard Mills writes about the recent, and very first, audit of the Federal Reserve
Bank that dictates our economy today. He writes, "Between December 2007 and June 2010 the
Federal Reserve secretly bailed out many world banks, corporations, and governments to the tune of giving away U.S. $16 Trillion dollars, most went outside our own country.
Doctors, if you are looking towards a bright wealthy future in medicine, you should do everything in
your power to protect what you already have---after all, in a few years from now you may very well be carrying weapons that politicians are now trying to restrict access to--likely already knowing what will really happen in a few short years from now.
Topic: "Why Permit Yourself To Destroy Your Own Medical Practice?"
It seems to me.......... that any doctor who has dedicated so many years of their lives to get a
medical education, without even mentioning the cost of it all, would never permit their medical
practice business to destroy all that bloody effort and cost. Yes, you can make a good income
practicing medicine in private practice by long hours of effort, increased frustration, and a
significant amount of neglect of your family and lifestyle.
All that does is lead to practice burnout, stagnation, and eventual drop of income to an uneducated person's level. It truly also takes the joy out of practicing when you are pushing huge numbers of patients through your office daily just to stay even financially. If you don't believe it, look around
at the doctors who are doing this, talk to them, find out why they are doing it--money?
All successful businesses require good management. You can earn high income for a short while, but
you learn to keep it, use it, and perpetuate it only by having a sound business that's well managed.
If you start a medical practice, you automatically have a small business going. When you
intentionally start a medical practice, you have an obligation to yourself to do anything necessary to
make the business side of practice function efficiently and profitably... am I wrong?
After all, this business becomes your livelihood, the source of all your income, the goal you have
worked for over a decade, and the most important asset that allows you freedom to enjoy your life.
So, why do over 95% of medical doctors neglect to do all they should do to polish that machine to perfection? I know, they're too busy curing patients to learn how to run the business for maximum productivity. Maybe, these doctors really don't give a damn anymore about their medical career goals
or the income they receive.
I believe the cause of that attitude is "passion burnout" more than anything else. That passion to
achieve has been burning in your mind for so many years, you have no energy left for perpetuating it
any further. That usually happens once your medical education and training has been completed. It's
just a relief to be able to call yourself a "doctor." You can't stop to lick your wounds, the battle isn't
over. The same thing happens often in life when you think about it. You wait a period of time to buy a special item or do a special thing and finally do it. You lug it home, unwrap it, try it out to see how it runs, use it once or twice, and they put it away in the closet and forget about it. You're on to the next new passion.
Isn't there something inside yourself telling you that you have a mountain of new stuff to do and
you're just getting started? Maybe you do, but you're thinking maybe about procrastinating a bit on
that effort? Then it never gets done. The best time to polish your well oiled money making business machine is when you start your medical practice and have the time to establish a business system for your practice. You'll be too busy to do anything like that later on. For most doctors, it's already well beyond that checkpoint.
You see, the same stuff has happened to me in my practice. Maintaining your passion to make your medical practice top notch is a lot more involved than seeing patients. You create that passion by establishing new goals--ones you likely can reach. Although you hate to do management of your office,
it has to be done somehow. You need to educate yourself how to run a business profitably and productively. Medical schools don't teach that and never will. You certainly can learn all the basics of business by reading all my articles on this website, including the books I recommend.
"It's not enough that we do our best;
sometimes we have to do what's required."
Common understanding tells you that no one is forcing you to learn about running a business well enough to bypass your competition, to reach your maximum potential as a physician, or to make
yourself wealthy, but it has it's advantages.
No one really cares whether you succeed or not, except for your immediate family who depend on
you for survival. After medical school no one is patting you on the back for working hard, doing a
good job, or being a great doctor. After 40 or so years of medical practice, there are no parades for
you, no standing ovations, no mention in the medical school alumni news except for your obituary,
and no one asking you how your practice years went. You get all that stuff from inside, your
confidence in yourself, your self-esteem, your patient's feedback, and your personal belief that you
are doing a fantastic job despite what others think.
If you need accolades and recognition, you need an academic medical practice in a big university
medical school and hospital where medical research, high status, and your publications worldwide
can do that for you.
At the end of the day, your satisfaction can only be fulfilled when you have proven to yourself who
you are. Thomas Edison puts it in a few words..
"If we did all the things in life we are capable of doing,
we would literally astound ourselves."
Topic: " Press Ganey--If you don't know what that is, you'd
better learn fast"
It seems to me... that the oppression, control, deliberate and intentional destructive process
pointed straight at the medical profession is now reaching a level of nightmarish height that hospitals
and physicians will be spending more time trying to protect their asses than to do what we are taught
to do... practice medicine and actually enjoy it.
This spiral is moving upward so fast that physicians will not be able in the future to practice what they were taught, live with the integrity the profession once had, and retain the independence of thought
and action so important to the business of and practice of medicine. This description of present and future medical life is best exemplified by PRESS GANEY.
Press Ganey is a little-recognized company, founded in 1985 by an anthropologist and sociologist from Notre Dame, to comply with the federal compulsory mandate required of hospitals. The federal
mandate required all hospitals to do patient surveys about how happy patients were with their
medical care. Naturally, guess who hospitals turned to at the time in order to comply--a small
company waiting on the sidelines to do the surveys for them--called Press Ganey? Oh yes, the
company was sold in 2003 to American Securities, a New York private equity firm for a reported
Let me point out to you a few of the consequences of this survey mandate that now is terrorizing hospitals and physicians. I suggest you read an excellent summary article about this in FORBES... January 21, 2013--by Kai Falkenberg--titled, "BAD MEDICINE."
- The theory under Obamacare: Betting that increased customer satisfaction will improve the quality of medical care and reduce costs.
- The teeth that create compliance: $850 million reduction of Medicare reimbursement fees for hospitals with the worst "satisfaction scores" in these mandated surveys.
- The dominant force behind the mandate: Giving patients everything they want and need to
be satisfied with their healthcare, forces hospitals and physicians to deviate from what they know
is the right medical care and treatment of patients in order to comply with the survey scores and mandate or be punished severely.
- Judgment relies totally on the patient satisfaction survey scores:In essence, medical reimbursement systems, medical liability environment, and clinical performance score-keepers ensure that hospitals and physicians will be rewarded for excess and penalized for not doing
enough in medical care of patients.
- Money drives medical professional behavior: Employed physician's compensation is
increasingly tied to their personal "patient satisfaction" scores, leading to increased over
treatment and over testing of patient's. Hospital fee reimbursement is directly tied to their
"patient satisfaction" survey scores.
- Employed physicians salaries rise and fall depending on their personal "patient satisfaction" scores: This blackmails hospitals or other healthcare delivery organizations,
who pay the physicians, to kowtow to the "scores" mandate to maintain their highest fee reimbursement for medical services to patients by paying employed physicians as much as $10,000 per year less if their "scores" are low.
- The 2002 CMS (Centers for Medicare and Medicaid Services) created a national
compulsory patient survey program for patient surveys and required public reporting
of the survey results: Survey programs processed 70 million patient surveys in 2011-2012
from 10,000 plus health care organizations and half of all U.S. hospitals. Patrick Ryan, CEO of
Press Ganey, already has predicted the next step---surveys of medical clinics and
- Results of this mandated patient survey system: Cost of medical care has increased
billions of dollars just from this one mandate that has no proof that it will reduce our healthcare
costs and has, instead, added billions of dollars to health care costs. The Cleveland Clinic now
spends $500,000 a year on government-dictated surveys.
Did I just hear a thunderous roar of outrage shaking my computer off the table? I thought so. Doctors love to be measured, rated, categorized, and investigated for their professional clinical care and backgrounds... don't they? When I think about the numbers of sites now "scoring" doctors on public media such as Kudzu.com, beenverified.com, healthgrades.com, and others, I see and understand
why the number of doctors is decreasing at a rapid pace.
You can't hide with your head in the sand expecting to achieve true success. It would be foolish
to simply roll over and play dead without at least making use of your creative muscle to avoid being brought into deeper bondage by the bottom feeders.
Fear dependency keeps you searching for a chink in the armor of increased control of healthcare, while you should be planning for, investigating, and finding ways to bypass the issue of increased
restrictions on medical care by physicians. Instead, be creative enough to discover one of many ways
to do much more with much fewer options. It's better to light a candle than try to cure darkness.
The ultimate indignation felt by every physician is evidenced by the government using an intellectually disgraceful criteria as the basis for improving health care which is unsupported by any acceptable measure of scientific study other than, "It seems like a good idea." Secondly, the surveys are flawed in multiple ways that begs repair. Thirdly, the simplest cost estimates to the government, actually to taxpayers, indicates that the cost of healthcare is increased by billions of dollars expecting the results
to be beneficial and cost saving.
The most regrettable aspect of it all is that physicians and all healthcare professionals are being involuntarily forced into compliance to a system that requires compromises in professional integrity, ethics, and honesty beyond any tolerance.
The insanity of those making the rules goes beyond comprehension. Unfortunately, the facts won't
be made available to the general public and the common person will continue to be led to believe
that the government knows best and doctors are too dumb to realize it.
"When people are least sure, they are often most dogmatic."
---John Kenneth Galbraith
Medical Practice Insights - 2012
Topic: "Retirement is something new physicians can no longer
afford to consider."
It seems to me.....there aren't many doctors, starting on day one of their new practice or day one of their employed position, that would have the perseverance to save 10% of all their net income monthly for the rest of their medical career. Let's say 30 years in practice. Suppose that your salary or net income per year was $100,000. By saving 10% of that each year for 30 years one could accumulate a retirement fund of $300,000.
It would be a rare person who could do that. As you know, that amount is ridiculously low for having any reasonable retirement, let alone pay for the college education of three kids. By present day standards this process would require your family to live on $90,000 a year for everything---and that is a low middle class range of income for any professional.
Doubling these figures gives you $600,000 in your fund. In today's economics, this would not do much better for you. If you then retired and lived on $50,000 per year, close to the same as some on social security recipients live on, you would run out of money in 12 years.
Since people are living lots longer now, and physicians are retiring earlier now(60 or sooner), you might need enough money to live comfortably for 30 to 40 years of retirement. And this is assuming you haven't made much money in the stock market or investments or paid for college costs for your children.
Something else has to happen to make this retirement worthwhile for a 60 year old physician and spouse:
So, what are the alternatives for you if you intend to retire:
Create a 3 million dollar retirement fund---at least.
Create an affluent medical practice in a high paying specialty.
Create and maintain another business outside your medical practice.
Have a rich uncle who left you a few million dollars.
Win the big lottery.
Marry a very wealthy spouse.
The last 3 are rare resources, and worthless to rely on. The most common response is to never retire, but even that is risky and not really dependable. Most doctors are probably not enthusiastic about becoming a plastic surgeon to accomplish
The bottom line here judging by what some doctors are doing, and by what seems to be the most reasonable option to add to your medical practice business is to create an outside personal business which can be started anytime in your medical career. Business experts who have made their millions in various businesses have long been proposing the ideal method for income---multisource income streams.
Business experts recommend starting a business in high school and continue to expand it in college and medical school. Many other sources of income arise from parallel businesses to your own over time. If you're a doctor, you could start a medical supply business, office decorating business, pharmacy business, medical equipment or office equipment business. Even partnering with someone who has worked in and knows the business well. Sharing a business with family members is not recommended for many reasons.
I hope you pick up on a few of these ideas and expand them into something of value.
Topic: "With Obamacare now legitimatized........"
It seems to me.....the practice of medicine will be forever changed and shortly be unrecognizable. These are what I see coming:
Midlevel providers (NPs, PAs, CNMs, and Administrative Nurses) will happily be jockeyed into much more medical practice responsibilities they have struggled to gain for years. It means that two major changes in medical-legal laws will be required to allow this expansion. First, medical practice laws that have been on the books will have to be revised to a significant degree to allow these medical care providers to be legally protected, and to expand the extent of what they are allowed to do.
Second, medical malpractice laws will have to revised to a considerable extent. If these midlevel providers will be increasing their risks for newly allowed procedures, two problems will arise for doctors.
1. If mid-level providers are required to remain under the supervision of doctors and permitted to do much more in medical care, the doctors who supervise them will be at higher risk and malpractice premiums will need to be increased proportionally.
2. If there are less medical doctors as the attrition of doctors continues, then the need to increase the use of midlevel providers will be necessary, more doctors will have to be involved and a larger number of doctors will be at risk in the process.
It's unlikely midlevel providers will be allowed to work independently, but I sure would not rule that out.
Need for increasing numbers of sub-specialized doctors will be necessary because primary care will basically be managed by midlevel providers and medical care problems outside the capability of a midlevel provider will be referred to specialists. In order for these specialists to financially survive, get enough referrals of patients, they will have to become subspecialists that manage only certain medical conditions within their specialty.
For example, it would be logical that CNMs would manage 80% of all OB care, so OB doctors will choose to do only C-sections, and a segment of infertility care such as microsurgery tuboplasty, IVF, infertility counseling.
GYN doctors would train separately and practice separately from OB care. Even they will need to sub-specialize in gyn segments of the specialty.
You probably are aware that building new medical schools will be a rare event, and that the 142 USA medical schools have no intention to enlarge their enrollment. So where will the increasing numbers of doctors going to come from to take care of our rapidly expanding population that we already have a shortage of.
Well, import more foreign doctors, make their licensure easier, because the educational costs for medical education have reached the limits affordable for over 90% of the American students. Governmental grants and scholarship aid debts for students is already at a trillion dollars with most now in default status.
Soon, the chore of recruiting American students will be overwhelming if it isn't already. Now you see up to 25% of medical school classes are foreign students. I wonder how soon they will have no American medical students in their classes? Perhaps the progressives planned it all that way----you know.....the World Order. That ought to solve the medical care problems.....right?
All medical doctors and other doctors will be employees of some agency, facility, hospital, governmental dept., or who knows what.
Private practice will not be an option in 2 years, with rare exceptions such as a "cash only" medical practice. I expect that the departure of medical doctors already in private medical practice will increase substantially in the next 2 years---already has been.
I detest the thought that doctors will be forced to work and practice under restrictions to medical practice from a boss or CEO. What I have noticed is that a great number of my medical school classmates who have spent their careers within the umbrella environment of medical education systems, large university hospital teaching centers, and places where medical education and training is involved have come through their careers of being employed, or contracted positions, feeling quite satisfied with themselves. That might be a good place to move into if possible, and if you don't plan on retiring early.
Your efforts to handle your next 10 years in medical practice will be far more difficult than graduating from medical school and far more stressful. If you watch TV programs, you may well know the show, HOUSE, where the doctor is an addict and a renegade, but brilliant minded. House himself, may be a model for the next generation of medical doctors should the medical profession become robots, taught to practice medicine using hundreds of protocols from which no deviations are allowed, and creativeness becomes non-existent.
Topic: "I have a wish"
It seems to me.....there must be a time when every doctor, nurse, medical assistant, hospital administrator, dentist, chiropractor, and osteopathic doctor (even medical students) wants to speak out to anyone who will listen about the gradual disintegration of private medical practice as we have known it in the past. Just of thought of no longer being able to practice medicine as you choose without the controls, fee regulation, medical malpractice burdens, and governmental interference is enough to depress any medical professional.
For those doctors who choose private practice, either in a group or solo, I am already freely providing all my business and clinical knowledge that I've accumulated over the last 60 years. I have no true idea whether you out there care at all about knowing what I publish and you read (hopefully). What I write about may be missing the point. Maybe even about things you consider to be of little value to your medical practice. But, I do know that what I am promoting to doctors is information and ideas and thoughts that you were not taught in medical school, and maybe even discovered while in medical practice.
What I need is feedback from all of you, good or bad, at any time you choose.
It would be all the more helpful to me and to you to know what it is that you have a deep need to have, get, or learn. No, I am not wealthy or I would be able to research and pay to find the answers I need to have in order to provide that specific and important support and help. Right now I'm guessing what's important to you.
Sure, what I send to you may be of value to a few of you, but that's never good enough. I want it to count for everyone who reads my newsletter, even though I doubt that is possible.
I will be sending you an email survey in the very near future that I hope you will honor by filling it out and returning it to me. For doing that, I will send you a FREE copy of my ebook, "The Business of Medical Practice" which I now sell over the Internet and on my other websites.
My aim is to eventually have this newsletter of mine read by 100,000 doctors or other medical professionals. That goal will be accomplished, but don't know how soon.
Sending me your thoughts, recommendations, and ideas about what you would like to know about medical practice even without the survey I will be sending out to you subscribers, will be an effort rewarded with a free copy of my ebook mentioned above.
Want to read about the ebook, go here.
Have a wonderful and productive day,
Topic: "Political Side of The Medical Profession That Sucks"
It seems to me.......judging by how the wind blows, that healthcare and the medical profession is about to sink into the quicksand of socialized medicine. I say that because it is highly likely that Obama will win his second term in office in spite of the overall sensibility of having a new path with a new president. It has become a popularity contest that overrides the minds of voters who aren't smart enough to open their minds to the facts.
From another point of view, if you are religiously oriented, God has decided to make us suffer at a much greater depth for the obvious purposeful direction of this country away from God, and certainly getting much worse daily. We deserve what we get, although there are a large group of Americans who understand the cure for a dictatorship and don't deserve what's coming down the line for them.
As a profession, we have never reached the level of power, prestige, and influence that medicine should have had all along. The reasons for that in my view began with the inadequate knowledge and education about politics that organized medicine has sent against the enemy--governmental intervention. Very similar to David meeting Goliath. Our warriors were doctors instead of politicians. Flailing a stethoscope at the enemy did nothing more than show how weak we have always been as a political opponent. I hear the usual complaints about why and you have too.
It's why the AMA has never succeeded in much of anything they have tried to do that truly made a difference. Doctors are never able to win over attorneys who basically dominate all politics and control of congress. Take a look at the several medical doctors in congress today. What have they accomplished walking around in the den of lions on capitol hill. It's like pissing in the ocean and expecting it to rise. Even hiring mercenaries to plead our case has resulted in nothing more than anticipation.
Ask yourself why the AMA has never been able to attract a significant physician membership all these years past. Even the threats of certain groups of doctors to stop practicing, or go on strike, was a pipedream after all.
It seems that it takes riots, major military threats to the USA, or upcoming chaos and collapse of our economy to make the changes that have to be made---even in medicine. A lot of people have to be hurt, killed, or imprisoned to instigate action.
The greatest mistakes that I see now that affect medical practice today are:
1. Believing that congress will ever cure the national debt problems. It means there will be ever increasing enforcement of healthcare regulations and discounting of doctor's incomes.
2. Believing that there will ever come a time when our political parties will ever agree on much of anything--therefore, complete inaction on anything--a stalemate that won't be resolved without civil violence of foreign invasion. That leaves the medical profession vulnerable to any act of the government.
3. Belief that anyone can do anything without money. Money creates power and influence. And along with that, comes greed. Which is why congress, and every governmental segment, even in each state, will never be free of corruption.
4. Belief by most doctors that they can reach their maximum potential and income without any business education or knowledge---which will never be taught to them during their education. Is there one medical school or even premed program that insists on a business education or provides it? Hell no!
5. Once Obama Care is in full swing over the next 4 years, I predict that private medical practice will become practically non-existent, that medical schools will have far fewer applications, that many more doctors will give up medical practice earlier, and worst of all, medicine will be practiced by government stipulated protocols made up for every element of health care and medical practice.
I suppose that a lot of you feel the same way about what's about to hit us in the face. It is a comfort not to practice anymore. And I feel for those doctors in the future who will have to contend with rigid practice guidelines. I hope I'm wrong about these things but my intuition tells me I'm right.
Medical Practice Marketing News
How to earn more and practice less
"Once difficult, now easy."   www.marketingamedicalpractice.com
Upcoming Article Titles:
1. So What.....why market my practice?
2. Advertising....a wart on the marketing finger.
3. I know.....you just don't have the time.
4. For the do-it-myself doctors.
5. Is the return on investment acceptable?
6. Marketing soup for the soul.
7. Are you at Level 3 yet?
8. Sacrifices that make you wealthy.
9. Satisfied with mediocre practice status?
10. Find the holy ground for medical practice
The more you keep reading this information and understand just how valuable it is to your practice and dreams, the more you think about implementing this important income producing process, and enjoying all
the benefits it brings to every physician who recognizes this as a wake-up call.
Marketing Strategies Mindset
Marketing principles are applicable to any business.....even medical practice. Most physicians
and you understand that and is exactly why you're reading this now. Usually doctors in practice are involved in one kind of promotion or another. Intermittent attempts at building a medical practice when you have time just doesn't cut it. It has to be planned, persistent and ongoing for the duration of your practice years. Let me give you several marketing strategies that are matched to medical practice.
1. Direct Mail Marketing: One of the oldest and still is a reliable and effective method of marketing. You simply send your patients mail to their home addresses through the regular mail. Whether you send them reminders of their upcoming appointments, dates of scheduled surgical procedures, annual appointment reminders, or lab test results, the reason for doing it must be in the form of necessary information or instruction. We all have done
However, what is sent and how its content impacts on the patient is where most medical practices miss one of the greatest opportunities for marketing (building) their practices. You see, it's not just pumping out the information you have to send them. It's the perfect opportunity to build a relationship with your patient that most doctors neglect. Of all the other doctors your patient sees during the process of their healthcare, who do you think he or she will remember first? Is it the doctor who takes a few seconds to scratch a personal note in the mail to them, the one who sends them a birthday, thanksgiving, or Christmas card every year, or the one who never does
such a thing.
What do you think your patient says to her friends in conversation about you? "My doctor sends me a birthday and thanksgiving card every year." Do you think her friends might be impressed at the quality and kindness of such a doctor? Do you think it may be something her friend's doctors never do? And when it comes to changing to a different doctor, who will they go to first?
Classic Rule of Marketing: Do what others are not doing!
Direct mail includes the use of postcards, announcements, educational materials, and even asking your patients to refer other patients to your practice. Whoa! Would you be revealing something bad about your practice to ask patients for referrals--like you are struggling to get by?
You would be pleasantly surprised at how much marketing your patients can do for your practice. First, it's an honor for a patient to be able to help their doctor. They have very few chances to do that. It's a marketing tactic called the Law of Reciprocity. Kevin Hogan, a guru of persuasion, says in his book The Science of Influence, reciprocity creates a debt in a very subtle way. Give away something of perceived value to someone, and others will feel compelled to do likewise.
2. Media Marketing: Radio interviews, filmed TV infomercials, podcasting, and press releases are a few of the methods used in increasing amounts today. Email marketing is particularly fitted to medical practice. Doctors have the names and addresses (marketing lists)
of all their patients. Of course, you are required by law to get their permission to send them an email... shouldn't be too hard to do.
What doctor's do you know have a dedicated phone line that patients can call in and listen to a recording about medical or health information? TV commercials by doctors is another profound method to become known and respected. The perception is that if you are that great to have been selected to be on TV, you must be an expert on the topic being discussed and probably
Podcasting is an easy inexpensive way to communicate with patients. Record your message, upload it to the Internet, and tell your patients the link or address they can "click on" using their computer to hear it whenever they choose.
3. Social Marketing: Some doctors take time to give informative lectures to local clubs, churches, businesses, societies, and medical assistant groups. It's a pleasant way to gain respect, confidence, trust, and popularity in your community. Not only are you doing a great community service for free, but also your prestige moves up 3 levels above doctors who can't find time
to do it.
Appearing at charity events as a sponsor or contributor places you out in front. Participating in community events of any kind exposes you to potential new patients. Showing your personal caring and your human side, is incredibly powerful.
4. Information Marketing: Any physician who writes a book is considered or perceived to be an expert---at least on that book topic. Writing articles for the local newspaper
or other print media spreads your name and knowledge to those who are looking for top doctors. If you don't feel you have the ability to write well, go to www.elance.com and ask one of their members to write them for you and with your name on it as well---like a 3 page article for 10
to 20 dollars.
5. Wag The Dog Marketing: Grab the tail of any marketing ideas you believe might build your practice and increase your income and go for it. Any second a new idea can pop up.
Some ideas might be:
--free handouts of some kind to patients that week.
--free pens with your name on them at the front checkout counter.
--hold a patient appreciation day, picnic, party---once a year.
--survey your patients to find out what their medical needs and wants are.
--advise your patients about what you learned at the medical meetings that's new.
--announce to patients changes in your practice functions and focus of your care.
--send a personal note to every patient you discharge from the hospital that week.
--ask busy doctors to send you their overflow of patients.
--send gift to the office staff of doctors who refer patients to you...for every patient.
--remember to thank any nurse in the hospital that refers patients to you.
--present a new congenial kind attitude towards everyone....be humble.
6. Yes, there are many more marketing strategies and tactics.
1. Barrage---use every marketing strategy at once.
2. Coupling---use two or more groups at a time.
3. Testing--use one strategy at a time and see how it works.
4. Intermittent--switching strategies off and on.
1. Personal responsibility.
2. Office Manager responsibility.
3. Marketing Professional responsibility.
4. Mixed responsibilities.
Curt Graham, M.D., L & C Internet Enterprises, Inc.
2404 Mason Ave. Las Vegas, NV 89102
E-mail = cgmdrx(at)marketingamedicalpractice.com
© Curtis Graham, M.D., L & C Internet Enterprises, Inc. All Rights Reserved.
Topic: "How do we keep private medical practice alive?"
It seems to me.......that there certainly must be a fair percentage of physicians graduating from medical school today who either have a desire to be an independent functioning medical care provider not caught up in the web of the managed care industry, or have a personality, attitude, or mindset about medical practice that is incompatible with the second level of restraints to medical practice (managed care groups). The first level is the US Government restraints on practice.
If, as the recent statistics and surveys of doctors tells us, the facts are true that 34% of doctors leaving the profession within 10 years (Modern Medicine, August 2012, Jackson Healthcare poll), right at the time that the baby boomers generation is reaching "Medicare-Age," Americans above 50 years old now are in for a rude awakening.
Either patients will be flooding the private doctor's offices or fighting to be seen by their HMO or Hospital employed doctors--either of which is a major crisis and division of the medical profession that can never be repaired.
Most of the media is overwhelmingly biased towards socialized medicine. What is even more disturbing is the same bias among the Academic Physicians promoting socialization of medicine. If you speak to physicians who have spent their practice life as an employee in the University Hospitals and Medical Schools, you will find that they are totally oblivious to the problems and concerns of private doctors. They are already brainwashed to the great advantages of the team approach to patient care (meaning doctors practice by a list of standards, procedures, and statistically driven outcomes of treatments).
Actually the team approach for medical treatment has been used by private doctors for decades. That's what medical consultations are for. I can't count the number of times I picked up the phone to get expert advice from other doctors I trusted. It could be called virtual teamwork--but at least I could select my experts instead of having them assigned for me to use. Does that ring a bell?
What happens to that, let's say, 25% of doctors who will remain after the
Will they eventually give up the struggle to remain in private practice? As I have been saying for the last several years, over half of medical doctor will quit the profession for economic reasons (Modern Medicine, Aug. 3, 2012, Diane Sofranec article, survey). They quit because their practice income will not support their medical practice remaining open, or don't make enough money to guarantee their family commitments, such as college for kids.
After being convinced they had entered a profession that was supposed to provide a substantial income, lifestyle, respect, and independence of educational judgments, being deprived of the whole package they bought into at the beginning suddenly recognized they had made a bad decision for their life career.
What strikes me is that physicians may leave private practice whether they could make a suitable income or not, because of the other reasons that 50% of doctor's serious frustrations stem from, is also a formidable cause for quitting. Add them all together and all hell will hit the fan soon, that is if we are still around after Dec. 21, 2012.
What seems to be so odd is the fact that there is apparently no problem recruiting medical students in spite of the $200,000 educational debt they accumulate before starting their medical practice---are they feeding the premed students some kind of drug that warps their analytic minds? Or, are all medical students from wealthy families only? When the scholarships shrink or disappear, what then? I predict that med school classes will be increasingly filled with foreign students in the future.
Do medical schools really believe that scholarship funds, funded by alumni medical school graduates, who will be quitting practice soon, is enough to sustain minorities in med school?
Lesson: My prediction is that every doctor that remains in private practice will need to have the equivalent of an MBA business education to survive in the near future.
Topic: "What is the one deciding factor that will always keep any physician in medical practice long term?"
It seems to me... in spite of all the various "reasons" doctors now quit medical practice, retire early, change careers, start other businesses, and are increasingly deeply frustrated with their professional careers today are in one way or another a direct consequence of the lack of an adequate income to meet their goals and needs. Just take a minute to think
In the conscious minds of every physician there have been an assortment of images that they have carried for years, imagined and seen for themselves in their future career as it evolves. These feelings and visions may have begun early in childhood or were later triggered by an event or circumstance that confirmed for them it was the right thing to do in their life. The choice was based on a strong belief that a medical career would satisfy their deepest yearnings to make a difference in the world, and provide the foundation for a happy life and fulfillment.
It may have started like that at the beginning for you. For many of the older physicians trained in the 1950's and 1960's, the fulfillment likely was a substantial element of their practices back then.
In the reality of today's world you experience a crumbling foundation under your medical career. Your medical career is not at all what you had envisioned. You recognize that you can't reach the goals you had set for your practice and for your lifestyle. You are very disappointed with your profession because it has let you down. Not only are you not happy in what you are doing, but also you now can see that all your dreams and plans may be unattainable--for all of the obvious reasons. Worst of all, you can't look ahead at your medical career in a positive light.
It means you have lost the hope that in the past motivated you to reach your present circumstances in your medical profession.......and it's a sickening sight to behold! Not something to be happy about or even proud about for many doctors. In spite of all this fire branding negativity you still have some very positive alternatives that I give you in my newsletters.
The core of the disintegrating medical professional career problem:
Give me the names of all the doctors you know of who appear happy and very satisfied with their private medical practice and their medical professional career and I will tell you that not one of them had an income less than $500,000 per year. It is quite evident to me that having a practice with a significant income such as this eliminates almost all the complaining, whining, and loss of medical practices we hear about today.
My view of the core problem is to ask the question, "How can doctors in clinical medical practice boost their incomes to the level for themselves that provides the hope, goals, fulfillment, happiness, and satisfaction that they need and want?" There's only one answer.
The answer is what I am preaching every day of my life to the physicians who want to hear. You will never in today's economy, increasing political interaction with healthcare, and unresponsiveness of the medical school training programs achieve anywhere near the life and career you wanted without implementing successful business strategies and systems into your medical practices. For those who aren't quite yet in tune with the essentials of successful business, marketing knowledge and strategies are a critical element of successful business principles.
I challenge anyone reading this to give me their own ideas and solutions to this incredibly destructive gauntlet physicians must go through just to survive, without even mentioning the issues of happiness in their careers, and satisfaction with their lifestyle with their families.
My email = email@example.com
Topic: "What Is It That Draws Patients To Your Medical Practice?"
It seems to me....... that 99% of doctors don't know the answer to that question. Wouldn't you think that knowing why your patients like you and are loyal returning patients would be a fantastic leverage bit of information you could use to cultivate your practice growth? Have you ever asked your patients why they stick with your practice and not the doc up the street from your office? What is it that you provide to them that they can't find in other practices?
What would happen if you discovered there were two or three major reasons why your patients chose you over everybody else? Wouldn't you quickly understand that if you focused on those two factors, you would most likely recruit an even greater number of patients, have a much more financially stable medical practice, and get more referrals? Then the question comes up, "Why do doctors not care about those issues that directly affect all aspects of their medical practice?"
A few reasons might be:
They don't care what the reasons are as long as they keep rolling in.
If I lose a few patients, I'll gain new patients to replace them.
If you like what I do...fine. If not, go to someone else.----plain arrogance.
Their only desire is to make money and not about whether a patient likes them.
Things will work to my benefit without catering to patients.
If I knew why they came to me, it probably would not be something I'd take action on anyway.
They think they are great just the way they are and have no reason to improve their relations with patients.
Even if patients like you, they will eventually go elsewhere else for some reason.
You can't socialize with patients and run your practice profitably.
Each one on this list indicates the complete lack of understanding of what makes a business successful--even a medical practice business. It points out the complete lack of business education. About 5 years later they notice that their practice growth and income has leveled off and wonder why. Entering medical practice with the right attitude, business knowledge, and the commitment to keep it growing until you retire is the only way that any doctor has a reasonable chance of reaching their highest potential in their profession.
Reasons why patients come to them, could be because:
Doctor explains everything thoroughly, presents all options of treatment.
Doctor lets me decide what choice of treatment I want to go with.
Doctor is very sociable and easy to talk to.
Doctor listens to me.
Doctor's staff is very personable and helpful.
Doctor is never in a hurry.
Doctor is respectful.
Doctor enjoys what he or she does and is recognized by all patients.
Doctor is very knowledgeable about medicine.
Doctor has a great reputation.
You can think-up a bunch more of these without much thought. If you meet all these criteria, then you must be a perfect doctor for everyone.......right? But you know that a doctor can't possibly please all their patients. With that in mind, you likely would like to know what it is about yourself that aggravates patients and work to change that issue you have. It certainly is not comfortable seeing a patient who dislikes you. This can lead to liability problems because this kind of patient only needs one convenient reason to sue you.
What would it take to encourage all doctors to survey their patients somehow to discover these factors that keep them coming back? You want patients in your practice that not only like you, but also are happy to refer other patients to you over the years. It make sense that a doctor should make great efforts to develop the habit patterns that's best suited to keeping patients, practice growth, and provide increasing revenue at the same time.
This is all about marketing yourself and your medical practice. It's a slow process that builds up over years of practice and should start at the beginning and be continued, never stopped, never intermittent.
Feedback from patients is very important to the direction your practice is going, and what goals you have for your practice over the long haul.
Remember--patient's rarely will tell you their honest feelings about you or your practice. You have to ask them to tell you, in a nice way of course. You can use a questionnaire with no signatures at the end--a mail in form--a form to fill out while waiting to see you.
Topic: "If doctors are all experts in healthcare, then why are there so many different opinions about how to treat the same disease?"
It seems to me......70 years ago that question never came up, and for good reason. Physicians were the boss and patients were just glad that there were some around to treat them properly, without ever a thought about challenging their doctor, his knowledge, or his advice.
We all see today how much that has changed. However, there have been a few add-ons to the healthcare issues and debate about what is right or wrong for medical treatment. At first, we got the best medical training we could and practiced with the skills and medical knowledge we had--even though we all continued to expand on both throughout our careers. Then we were criticized by politicians and others for not providing the best care possible. The medical hierarchy was intimidated by that, so we got CME pushed in our faces, which most of us were already doing appropriately--it's just part of our mindset as physicians.
In the 1970s' the costs of medical care were rising, big surprise I guess, and large corporations and unions essentially forced the government to start dictating to doctors what they envisioned as best healthcare. They added Managed Care into the already complex healthcare formula thinking they could provide "best" care at a cheaper cost--and failed. Medical care then became addicted to the concept of evidence based medicine, which had been an integrated part of healthcare years prior--funny that outsiders never noticed that earlier.
Along came a new set of pro-government health experts who were joined by complicit medical doctors who developed the "quality of care" dogma, which resulted in "best practices" criteria. At this point health care costs were continuing to rise (never had stopped rising or even leveled off), but now the experts were involved with, and supported by, a very lucrative medical industry of "controls." Doctors now are going to get report cards and graded on criteria derived by experts to be quality of care.
Throw a wrench into the the system, then what?
There are a pile of wrenches that continue to stagger the brilliant minds of social and governmental economic experts outside of medicine.
1. The quality criteria about best practices is assumed to be the best, so compliance is the only option.
2. The basic criteria is guesswork because patients do not respond to the same treatment or medication for the same disease or health problem the same way.
3. The latest news reports that research based medical evidence may in many cases be in error, and the doctors have been fed wrong medical data to treat patients with.
4. The wrong medical evidence and studies came about because the results came off a pile of statistics, computer material analysis, and little attention to patient testing and results where real results are proven.
5. Throw in the fact that a large part of medicine today is a consequence of dictation by patients themselves. Some do what the doctor advises, some don't. Why should anyone trust a doctor today? So, if patients control their own care, then all medical treatment results are inaccurate and the research data is skewed. Likely, most patient data results will remain subjective in any study.
6. Now, the non-medical experts, governmental, political-economic think tanks, and even those physicians in high places who think in terms of insuring quality of care for everyone believe it can be done--yet they all continue to spit into the wind.
7. Medical care will never be available to everyone no matter what is tried and forced on the population. This can only mean that government is doing all this to create more control of people and power, all the while forgetting that medicine isn't a predictable, scientific step-by-step criteria that fits everyone.
8. Doctors will never be open to do their best care when such things as fee controls, lack of medical malpractice verdict caps, extreme costs and debt of medical education that cripple any graduating doctor's chance of paying off the debts and start private practice, and the continued disintegration of medical doctors status as a professional are present--way too many rules to live by that make good decisions almost impossible.
I suggest you read a WSJ article March 31, 2012-C3 by Pamela Hartzband and Jerome Groopman, titled, "Rise fo the Medical Expertocracy" for further illumination on this topic. It's going to be a wild ride for new medical students facing the future of medicine. My ultimate question remains about the future of medicine, what would happen if all pre-med students were told everything about the problems in medical practice today? Would it make any difference to them or their choices? Or would they continue to follow their dream no matter the consequences?
Topic: "My Medical School Classmate's Opinion"
(My best friend's thoughts about my mission to get business education for all doctors included in the curriculum somehow someday)
It seems to me..........an opinion from a good friend who went through med school with me, exposed to the same education benefits, would be a good place to bounce my ideas off of. His response was not unexpected and actually was a profound confirmation of an academic's views and knowledge they have about the severe financial problems doctors in private practice are having. They think and wallow in a medical world quite distant from private practice reality. Therefore, they ignore it, refuse to believe it's as bad as it is, and find it extremely difficult to understand how it could be possible.
In addition, they are so busy making sure that med students, residents, and others in training get what they think are the necessary basics of medical office business finances----using coding and billing, medical record upkeep and methods, using current technology to handle their business, the best practice computer software and hardware, management of overhead costs, and working with financial advisors, etc.
My friend Nick did his residency in Family Practice, then returned to his home town hospital as an employee for the next 45 plus years. During that time he created a full internal medicine residency program at the hospital and ran that program. He is director of one of the elite university medical school programs (Director of the Primary Care Review) in Philadelphia, creates workshops on billing and coding, attends lots of medical education courses and curriculum structure planning. Practice management education is left to the PA Academy of Family Practice and PA Medical Society to educate FP doctors.
He tells me that most medical practice management education is left to the medical societies, specialty societies, and NOT medical schools. Beyond that are the courses doctors take from Conomikes Associates, The Practice Management Institute, and the American Academy of Medical Management. Strange, how much that sounds like the system used 40 or more years ago.
It's quite clear to me that the only business education physicians are receiving today is fragmented, overlapping, and catch as catch can in disjointed one hour sessions and bursts of strategies and tactics. Doesn't that seem like medical schools have simply dumped the doctors out into the business world without any small business education whatsoever and expect them to do well, be profitable, and happily donate millions of dollars back to their med schools? And they simply hope their graduates pay tribute back to the schools that shortchanged them to begin with. Who's kidding who?
They are insulting my intelligence and the doctors who recognize the truth when they see it.
Who are the practice management experts brought in from "outside" to teach doctors about practice management?
Have any of those experts practiced medicine? Have they learned about all that by books, college courses, and talking with doctors? Practice management is much more complicated and difficult to learn than listening to an hour lecture, or CD, presented by a marketing company that has a financial motive prejudice.
What doctors need and can reliably use are the business systems appropriate for medical offices, details in depth of business management techniques, and be shown what works with medical practice, what marketing strategies are currently most beneficial, and why.
Those imported to teach doctors about business and marketing, are those who are least qualified to do so. I've been there at national medical meetings and listened to them. I don't go to them now because I can't tolerate the lousy quality of business being taught by those people who don't understand a doctor's mindset.
Personally, I believe that having a doctor read the top 10 business and marketing books available today would be of much more value to their business education than a hundred slip-shod lectures on the topics.
With a DVD or CD set of teaching products created with medical practice business in mind, at least a student or doctor would have the advantage of being able to go back to those over and over to refresh their minds. Someone needs to create those products who has a dominant and extensive knowledge of the business of medical practice.
You do have the option and benefit of the ebook that I published on the topic: HERE
Topic: "Doctors Struggle to Make Ends Meet"
(Maybe the country is finally waking up to every doctor's dilemma.)
It seems to me.........that the title above that I found in the latest issue of the WSJ did not say nearly enough about the financial problems doctors are facing in the article below the headline. Even the doctors at the Westminster Medical Clinic, after receiving funding from health insurance companies and elsewhere don't even begin to keep the Clinic above water. They can't even pay off their previous loan, let alone hire enough good help to ease the pain.
The basis of every problem in dealing out healthcare is money--who's going to pay for it. The health insurance companies are demanding that medical doctors around the country provide top medical care, in spite of the fact most doctors aren't making anywhere near enough money to come close to the level of care they all wish they could. Why is this fact not even mentioned in every newspaper in the country?
There's no doubt in my aged mind that the perfect storm is coming very soon in medical practice. So far the governmental fee restrictions have created an avalanche of attrition of doctors as well as managed to use that financial situation to remove private practice of medicine by 2013 or soon after. Hell, in 2005 private practice doctors made up only about 50% of the practicing doctors. by 2012 that number has reduced to about 33% of doctors. So it appears the predictions are right on.
What do I think the perfect storm will cause?
First, if a physician doesn't make enough money to remain solvent in private practice, and can't afford to pay experts about $30,000 per year to do all their business management and marketing for them--the education doctors never were taught, what would you do? If I weren't already retired from practice, I certainly would quit medical practice completely. Private Medical practice has become a liability that can't be sustained. Much more money can be made in other businesses unrelated to medical practice.
Second, training doctors to become superb technologists rather than thinkers won't work. What do you think you would do with your medical career if you had an MBA degree as well as an MD? We have an increasing population, right? Medical schools have made it quite clear that they aren't planning on increasing the size of their classes. A couple new schools are supposedly being built.
With this set-up the majority of healthcare/medical care will be transferred to non-physician personnel. Medical mistakes will increase for obvious reasons. Malpractice suits will continue to increase significantly because of that. Fewer doctors means they will become managers of care and not producers of medical care.
Third, I expect there to be a complete change in the medical education system soon. Likely, an MD degree will be intermixed with an MBA degree routinely which will require a 5 or 6 year curriculum for doctors. Comparing the amount of medical knowledge taught to me in 1958 to 1962 with 20 times that of medical education now being jammed into that same exact span of school time, means problems.
Either the medical students now are all members of MENSA or the GENIUS SOCIETY or medical students now are only learning a small portion of the medical knowledge available. This factor will eventually create a zillion mini-subspecialists who can learn it all in 4 years time. That's why EMR's are essential now to compensate for what will be needed in the future. Patients can then make multiple office visits in a day, like see the eye doctor, then the ENT doctor, then the neurologist, as they wander along the hallway of the medical building. And remember robots--well many hospitals now have functional robots doing menial jobs which will soon be seeing patients, at least to do blood pressures, temp, and pulse rates--later monitor direct cardiac activity which is sent to the doctor miles away by wireless.
Maybe the whole confusing, inadequate, outdated, broken healthcare system will be cured of those diseases on Dec. 21, 2012?
Topic: "The best Plan B that I've found for private medical practice"
(The best offense for doctors fighting government control and restrictions on healthcare)
It seems to me......... that Brian Forrest, M.D. from a town in N. Carolina has set a good example for all doctors in private practice to give serious consideration to. It may also be something that physicians and other professional healthcare providers who are not entirely satisfied with their employed status may also find quite appetizing.
I figure if there's any way that doctors can beat the government at it's own game, we need to grab the opportunity today. Dr. Forrest, like so many other physicians across the country are feeling the impact of, just got sick and tired of fighting the complexities of the current healthcare system, billing complexities, constant battle with the health insurance carriers over fees and claims, and government restrictions.
Dr. Forrest quit accepting any form of healthcare insurance in his practice. He decided to move into a cash only practice. Such a move always involves losing patients who are unwilling to pay cash for medical care or are locked into a healthcare contract they are unable to break for various reasons. To make it possible to retain a good number of patients that he would have otherwise lost, he formulated a system for medical care, which required an annual fee of $399 per year per patient for all office medical care.
That happens to be almost exactly what the Concierge practices around the country are charging their patients and doing quite well financially. Concierge practices normally funnel down their practice to around 300 to 400 patients. Doctors are then able to spend much more time with patients and practice better medicine at the same time. It reduces frustration so common among doctors who choose to use patient volume increases to compensate for maintaining a reasonable practice income.
Even more profitable is the fact that collection costs go to zero dollars and the office overhead is reduced about 66%. Now, if you multiply 400 patients by $400 you get an annual gross income of $160,000 and get to keep a large portion of that to take home. Add to that the extra cash charges Dr. Forrest imposes on lab work and office supplies used for the patient's care, and the charges made for hospital rounds or hospital consults on a patient--not a bad deal at all!
It gets even better if two or three doctors form a group and share overhead expenses. Dr. Forrest along with two other doctors created their own "direct-buy" health plan that businesses can purchase for their employees instead of the traditional health insurance.
Amazingly, under the "Obamacare" rules, providing this care method exempts employers both from requirement to provide insurance and the fines/tax for not doing so. It's a win-win. But these doctors aren't done yet.
The are now franchising their system out to other interested physicians while making a few more bucks in their side business. Dr. Chris Tomshack has done the same thing with chiropractic doctors.
What's the motivation to do this transition to a cash only practice? The 2,200 page Obamacare Bill passed by congress has 1,700 different directives to existent and new federal agencies, boards, committees, and czars to establish complex rules and regulations that, when done, will require at least 100,000 pages to catalog plus footnotes and references to over 25,000 other documents, rules, and regulations.
It seems quite probable that the traditional medical practice will require full time employees just to handle these complexities regarding medical practice, which will increase the overhead costs even more.
It's a picture that gives me a headache just thinking about it all. In case you haven't noticed, hospitals and other healthcare provider groups are dramatically increasing their recruiting efforts for doctors and medical practices.
I don't know about you, but this sure appeals to me, even as a medical practice retiree.
Topic: "About making doctor's more efficient"
"Efficiency can be improved, but not by making doctors work harder."
It seems to me.......... that the effort by healthcare investors and promoters, such as Athena, Watermark, Alere, and Itriage and other startups, have been sucked into the "herd effect" belief that any doctor's efficiency problem can be resolved with technological advances as described in an article in Fortune magazine Jan. 16, 2012 titled "The Wired Doctor."
Such nomadic wanderings are pumped up by those organizations seeking to grab into the government business handouts of tax payer money. What hasn't been recognized by most are the roots of doctor inefficiency that certainly can be improved long term by starting with business knowledge and systems... not technology.
You can give any amount of healthcare technology to doctors to use and these digital elements will only succeed in shortening the time spent on data accumulation, recording, and dispersion. It doesn't improve the basic efficiency of the process of health care delivery in the medical
What will it take to improve a doctor's efficiency at delivering healthcare?
I definitely can't criticize the focus on technology as the means to improve efficiency without offering some other reasonable and attainable solutions. Knowing that over the last two decades every provider of healthcare has been struggling to find a way to improve the efficiency of our system that truly makes a difference--and haven't found one.
The flaw in the mindset is that a physician's efficiency is attributed to his or her lack of time shortening "toys." It's obvious to me that a doctor's efficiency depends on personal interactions, not technical. If you want to build a house in one month instead of 6 months, you would need to hire employees (experienced carpenters) who have the knowledge of how to build a house, what is constructed first and second and third, and understand the interactions of the whole team to make it happen.
Sure, you can add some efficiency to the house building process by providing the most up to date tools. But if the interactions of the team is not coordinated well and certain steps of the building are completed out of sync (and need to be torn out) and rebuilt in the proper sequence, it'll take 6 months to complete the project.
If hospitals that buy physician's practices as satellite feeders truly understood that almost all physician(s) running that practice have no sound business and marketing knowledge, a circumstance found all over the profession today, then they have just taken on a business "disabled" employee that adds to their inefficiency instead of improving it.
If hospitals would give those doctors good business training, which would make them a huge asset to the hospital, the healthcare system would be greatly improved. And, those doctors and practices that hospitals acquire would not be a business burden, as they seem to be now, anymore. They'd be a highly profitable asset.
Improving the efficiency in your private medical office:
The above ideas can be used in any doctor's office by following some very reasonable and profitable rules of thumb.
1. Hire only "medical office experienced" employees: If you have to spend the time and effort to train inexperienced employees, you waste time and effort (and income as well) getting them up to the job position requirements you desire. You will need an understanding about the efficiency of medical office business functions that go much deeper than you may think in order to hire the right person for the job. Try hiring your friend's daughter just out of high school to get cheap labor and you likely will consider self-immolation.
You'll have to sacrifice elsewhere in order to afford to pay the salary of an experienced medical office staff member.......no new car for 3 more years, for example. The sacrifices to do this hurt, but in the long run you will be amply rewarded for your persistence. Those who advertise the most make the most money in their business. The same applies to your willingness to pay top salaries, even though you may not believe that now. It's an undisputed fact in business.
2. Replace any office employee immediately, who isn't going beyond the usual office duties: You must pay close attention to what your office and business staff are doing that qualifies them to remain an employee.
Some bad signals that you may notice:
Repeatedly arriving late to work--even if it's only 10 minutes.
Often leave work early for no particular reason except to cheat on the
8 hours work agreed to.
Inability to see office work that needs to be done before leaving the office.
Procrastinating nature in their work ethic.
Get upset with whining patients and show their frustration.
Refusal to assist in completing other staff members work before the end of
the office day when theirs has been completed early.
Hesitant to take over another staff members duties in case of absence
Personality clashes with other staff members, either quietly aggressive
Stealing from office supplies for home use.
Conflicts with other doctor's office personnel.
Refusal to wear office uniforms for personal reasons.
Difficulty in dealing with a hostile patient.
The exemplary qualities you should look for...
No problem arriving at the office earlier than when office officially opens to do
the chores like pulling patient charts that weren't done the day before, or to
grab a bite of breakfast before patients arrive.
No problem with staying overtime in the office when appointments drift later
than usual or are delayed because of emergencies that take the doctor's
time to resolve.
Happy to help other staff members complete their tasks for the day.
Accept the fact that work (beyond the 8 hours they were hired for each day)
will somehow be compensated for by extra time or days off for family or
Are in the habit of rarely saying anything derogatory about anyone.
Spontaneously come up with good office ideas to make things more efficient.
Are comfortable working without repeated supervision.
Complete jobs that are started.....on time and done thoroughly.
Show strong loyalty to the doctor and office reputation.
Refer friends, neighbors, or acquaintances to their doctor's care.
Demonstrate a "positive" attitude and upbeat personality.
Dress appropriately for the job they want to have.
3. Insure and reinforce continued learning and training of office staff: Everyone has an obligation to keep up with the world around them.......especially in the business arena. Do your own teaching, offer to pay for courses your staff might want to take and you see the benefit it will have to your practice, or hire people to teach your staff about efficient business processes.
4. Demonstrate your support of your staff continually and repeatedly: Employees work harder, do a better job, and are much less frustrated when they know their work efforts are appreciated. Go a month in your office without handing out one single compliment or gesture supporting your staff and you'll see slacking work, procrastination, and inattention to their duties. That's your job......do it with tenacity.
5. Efficiency comes with knowing how businesses work and implementing the business principles. If you don't know... learn them. If you don't have time to improve your own knowledge... you will never be able to improve your medical office business. Your office is inefficient because you don't care to make it any better. If you did care about making more money in your profession, you would do what it takes to get there. To do so, will probably mean you will have to skip a few ski vacations, travel abroad, or buying a new fashionable home.
It seems to me that the whole medical profession, especially the medical education institutions, have lost all perspective about the issue of medical professional's survival by ignoring the obvious causes of healthcare inefficiency, hence decreasing business incomes and increasing doctor frustration with their careers.
If Mr. Perelman can donate $150,000,000 to the University of Pennsylvania's medical school, why aren't there other millionaires out there willing and able to put "business" education into the medical profession?
One of the most irritating examples of business support for college graduates who use college as a stepping stone to becoming a professional athlete, is the STAR MBA program recently created and organized. Several elite university business schools have coordinated their business programs for pro-athletes who after a few years drop out of the pro leagues flat broke. Made millions of dollars and blew it all. It's a damn shame... right?
What is more interesting about the STAR MBA program is that it is a home education program, done at one's own learning speed, with a few on site requirements while enabling them to continue with what jobs they might get. It makes me wonder what the four years in college did for them, academic wise, if anything.
Now, if these elite business educators had the least bit of intellectual brilliance, they would be able to perceive another group of professionals who need that same help far more than professional athletes... doctors, dentists, and even attorneys.
Wouldn't you want to grab on to any offer like this for business education while continuing to practice medicine? Of course, this would only pertain to doctors who would love to earn more and work less while earning a few million dollars during their practice career more than they ever will in their present situation.
Ignorance has some fantastic advantages. You would never know what you were losing in terms of practice income. You would never become aware of how the rich get rich. You would continue to think there isn't anything better than what you already have, subject to luck and external circumstances. Stupid can't be fixed, but ignorance can be repaired."We are all faced with great opportunities brilliantly
disguised as impossible situations."
Medical Practice Insights - 2011
About-----"Preparing now for what your medical practice and you will
face in the near and distant future.
It seems to me..........all physicians, doctors, dentists, and other professional health
care providers need to see the possible future of medicine with fresh eyes. Economic
changes and trends in healthcare sway with the breeze. Keeping up with what's happening
in the world around you, outside medical care, will give you early clues. The most efficient
way to follow the trends in medical care is not to rely on what you read and see published
by those in the think tanks of healthcare.
In my mind the best way to judge where medicine is going by what patients expect from
doctors and the medical profession. Over the past 30 years things have changed in the seller-buyer world from a medical profession that told patients what they should do, to patients
being the driving force for what happens in medical care in the future. Politics aside,
patients are medically smart enough now to know good treatment from bad, good medical
advice from bad, and good providers of medical care from bad.
Patients are well aware of their power and dominance while seeking the best healthcare.
Because of their influence on the kinds of medical care they prefer, it is urgently wise to do
what is possible in medical practice to comply with what patients accept and demand from
their doctors. If you don't catch on to that, they go elsewhere. Medical practice competition, especially in urban areas, has become something to contend with.
In 2012 patient's want more time with the medical providers. To get that, patients are
preferring the midlevel medical providers over the traditional patient-physician interaction. Perhaps you have noticed that is your practice?
Patients are demanding more medical information and education than ever before. It's a very good reason to be the one doctor in your community to provide medical information handouts
for your patients----the ones you create yourself, not the ones created by medical
organizations with slick covers and such watered down information. Patients want to know
what you, their doctor, thinks and knows about various medical issues, symptoms, and treatments. They trust you, not something provided by some writer with unknown
Keep asking your patients what they feel about doctors, want in the medical care.
In preparation for the future, you might want to consider these changes:
1. Employing midlevel providers (Nurse Practitioners, Physician Assistants, Certified Nurse Midwives) and using them to spread your medical practice work load out, which results in
your have more time to spend on more complicated medical patient issues and problems.
There is no doubt that these individuals are a productive and profitable asset for any medical practice if used properly.
Many physicians already employ them and understand their value to the practice. Some great positive attributes are...
Patients have much less waiting time to be seen... long waits to see the doctor is
probably the biggest complaint in medical care today.
Midlevel providers commonly spend more time with and give out more educational information to patients that doctors have time to do... a need patients have which is
Midlevel providers communicate better with patients because they stay away from
lots of technical medical terms.
They show more sympathy and empathy than doctors.
2. Prepare for changes in your practice focus: Ever wonder why you are hearing stories
about cardiac surgeons who have lost their practices as a result of a massive increase in non-surgical procedures done by invasive cardiologists and radiologists that make bypass surgery unnecessary?
With the vast increase in sub-specialization in the USA, even the world, patients now ask for those specialists that are highly focused on a narrow segment of medical care and treatment... even if their fees are much higher and health insurance coverage is nil. It's a logical trend
when you consider the vast amount of medical knowledge and information being added to
the profession daily makes it nearly impossible for any doctor to keep up with. I predict that
my specialty will divide into Obstetrics and Gynecology as separate entities in the near future.
I'm reminded of a comment one of my foreign OBG residents said to me the day she quit and headed for Canada--"If there's anything I hate more than Obstetrics, it's gynecology."
You may have to stop doing parts of your present medical practice just to remain current in
your knowledge of the areas you want to continue with.
3. Move your medical practice: This would be the perfect time, before the national
healthcare law (after all the upcoming adjustments are made by late 2013, let's say) become rigid, to move your practice to a much more profitable area of the country, or area of your
own city. If you've had a good taste of your practice income flow, patient flow, and future potential for growth where you have been practicing up to now, and find it disappointing, it would be smarter to move your practice to an area you may already be thinking of right now.
One of the problems that healthcare faces today is the relatively large numbers of medical doctors who move each year, by AMA surveys. The 15% of doctors that move around creates
a gap in medical care and patient access to medical care. I wouldn't be a bit surprised if the healthcare law eventually will prohibit doctors from moving around from place to place... pick
a spot and are forced to practice there forever, regardless of the financial and practice
problems you have to tolerate.
According to the most credible economists, demographic research is showing that the most profitable practice areas in the future will be in the midwest of our country where living costs have always been less than in coastal areas. Studies also show that settling in towns around 100,000 people and that have a college or university there provides for the long term family satisfaction relating to educational and cultural advantages.
Spend more time thinking about these things and others that come to mind. Make some early decisions now that will affect your medical and personal lifestyle later no matter what else happens in this country.
"Nobody except a baby in wet diapers really welcomes change"
November -- October 2011:
"Why Is It That Doctors Fail To See, Understand The Absolute Requirement And Importance Of Business Knowledge/Education, And Do Nothing About It"
---when it makes all the difference in their practice income,
profitability, and success in their profession.
It seems to me..........the results available from even the slightest efforts made from implementing business and marketing strategies into a medical practice far exceed
expectations. You'll never make me believe that physicians have no idea what business
strategies and marketing can do for their medical practice. The do know because they are bombarded with various elements of business and marketing daily, on TV, road signs, newspapers, radio, among others.
Logically, even the dumbest individuals understand that marketing must produce results
because why else would millions of businesses of all sizes spend billions of dollars annually
doing marketing and advertising. Obviously, businesses that do no marketing at all don't get many customers, don't make much money, and usually fail within a few years in business.
That's the reason 95% of small businesses fail within 5 years after startup--a well
So......doctors know what any business has to do to stay in business. They know how much
that marketing adds to business success. Doctors also understand what happens when their medical practice business is poorly managed and disorganized. Income drops, billing is intermittent, employees are unsure what to do next, scheduling of patients is disrupted, more patients complain, are just a few of the untoward events that occur because of the lack of business systems that keep an office organized.
Is there any question that doctors know, by common sense, what should be implemented
into their medical practice businesses? The enigma is, why don't they make it a priority?
Out of the physician population who are in private solo or group practices in this country, what percent of those consult with business and marketing experts in any degree or format? I don't know the statistics, but I'd wager not more than 5%.
What factors might be reasons that doctors avoid learning business strategies and systems, as well as marketing strategies?
1. Lack of discretionary income in their practice?
2. Distrust in those who try to tell them the remarkable advantages of
knowing business and marketing top to bottom?
3. Fear of failure in making efforts in business and marketing that fail?
4. Too busy in practice to go back and learn business principles?
5. Stuck in a dimension of inertia and satisfied with what they have
6. Burned out of the need, education, productivity, and income cycles?
7. Just another issue that separates them from family interaction?
8. Do not have the self-confidence that they can make the education
work for them?
9. Already tried following business advice and never helped?
10. Just don't believe that any business knowledge or marketing
strategies would do any better for their practice growth and income
than they already are doing?
11. Medical education clearly implied that business knowledge was
12. Too hard to learn all the business stuff I would need to know to
create any significant improvements?
13. Just don't give a damn about learning new stuff even if it might help?
14. Have no desire or ambition to reach my highest potential in practice?
15. I know enough to do all that stuff already?
16. I would probably need an MBA from Harvard Business School to do
what I'd need to learn and do?
17. Soon all doctors will be forced into employee positions and won't
need to do the business and marketing stuff?
18. Even if I do learn all that stuff about business and marketing, constant
updating it would create another ongoing job for me in addition
to seeing patients?
19. I would be forced to hire a trained medical office manager and pay
a big salary?
20. No matter what I do, I can never reach the goals in practice that I
21. I'm quitting practice--too frustrating to put up with?
22. I'm changing careers to earn more money than I can make in
23. Increasing Government fee restrictions will never stop, so why
learn ways to improve my practice when sooner or later I can't
financially survive in practice?
24. Malpractice litigation and threats don't make improving my
practice a priority, because that will be taken away by a jury
25. I'm looking for other alternatives for managing my medical practice?
26. My practice business is different--business and marketing learning
27. My good loyal employees would never tolerate big changes in the
28. I'm not the kind of doctor who can fire employees if the new
business stuff required it?
29. Just don't believe what the business experts say?
30. I've already accepted the fact that I will never be able to earn
enough in medical practice to make any business changes
These factors and others don't drum up a strong stimulation for any doctor or other healthcare provider to make learning highly productive business strategies a priority. If these medical warriors would tell me how they feel and what they think about gaining business knowledge
and about their biggest medical practice problems, I would be able to create solutions for
what they need to circumvent the issues that bother them the most.
I am confident there are answers and alternatives for any of these issues, but I have the
feeling most doctors don't believe it.
If the reason doctors aren't grabbing on to the opportunities rapidly is a mixture of everything above, then no one wins. But, I don't believe that's the case. It seems obvious to me that
each medical professional has one specific, maybe two, ongoing practice frustration that is strangling them. If those were resolved, doctors would be much more satisfied with their
medical practice. Maybe practice more years before retiring.
My profound belief is that business knowledge, once learned and applied, will cure 90% of
those frustrations, and that when the income from the practice becomes stable and
increasing as a result of that business knowledge medical practice would be enjoyable
Topic: "Why Do Medical Schools Refuse To Teach Medical Students Business and Marketing--At Least The Basics and Principles?"
It seems to me... that it's time to stand up against the tyranny of the medical
education system. What gives them the right to decide that the primary foundation of a
medical career (the business of medical practice) doesn't deserve a lick of academic
Is there any doubt in the minds of any physician anywhere in the world who has their own medical practice that the lack of education about running a medical practice business successfully, requires knowledge they have not been taught during their medical education?
Just the fact that the medical education system knows that they are now graduating large numbers of qualified medical doctors who will fail in their practices because of having no business education, is not only neglectful, but also a malicious agenda composed of political, money, time, and expense elements.
Many will defend that position as being an unaffordable addition to the medical curriculum,
when we all know that every medical school receives government money and support for
millions of dollars of research they do. My question is, are medical schools created to teach medicine, to do research, or both? Does the research money end up supporting the medical school teaching program, otherwise medical schools would go out of business?
My other concern is how the medical school system is able to rationalize pumping out medical doctors who they know full well that many will not do well in their medical practice business because of lack of business education. The unbelievable part of this is that they are at ease
doing this at a time when doctors are overwhelmingly frustrated with medical practice and
now are quitting in droves. All done at a time when the need for physicians is
Along this same line, wouldn't you think that it would be much more intelligent to admit
medical students who intend to practice full time instead of intermittently? That again brings
up the problem of women doctors in medicine. Statistically, 50% of women doctors surveyed practice part time. It may be a blessing to the managed care groups who employ most of
them, but not to the smaller communities in need of doctors. Are those doctor attrition rates quoted in medical practice surveys factored into the medical schools production rate of
If one took the time to look at how each medical doctor after graduation chose to practice,
how long they lasted in private practice and what they did next, and look at the real reasons
40% of doctors admit being very frustrated with their profession, I think we would quickly
see that the number one cause is lack of practice income enough to stay in practice. And
what would be the cause of that?
If a doctor can't afford to stay in private practice there must be a reason. Let's not blame it
on laziness, inertia, or lack of motivation. Very few doctors fit these categories. It's quite
obvious to me that a doctor who has a bang-up medical education and has no business knowledge, will never rise above a mediocre practice level by any standard of measurement.
Lack of business knowledge means they lack income. Lack of income means they are forced to quit practice and take on the role of a medical employee. But, what about those who go into another profession, job or business. Yes, it's another
form of doctor attrition.
When a doctor has the appropriate business knowledge, they also have all the business and marketing tools to make the income they want and need. Others have no idea how to do all
that when they get in financial problems with their practices. Yet, any doctor can resolve
that by obtaining the business knowledge and using it.
Criticizing without offering solutions is something I don't abide by. So here's my ideas about solving the problem of under-trained doctors.
I've written about these solutions previously in my ebook and articles, but newer ideas come
to mind. With almost certainty we know that there will not be one medical school take on the task of teaching medical students the essential elements of business to insure that doctors
leave the school prepared to run a business successfully. But, it's much more than just being able to create a successful
This specific knowledge prepares doctors to reach their full potential in their career while
having the tools to defend themselves successfully from governmental intrusions into
healthcare. The economic restrictions that are created against the practice of medicine, the
abuse of a legal system, which intentionally avoids enacting malpractice caps on pain and suffering, and the increasing toll on the lives and families of physicians are a few destructive factors all physicians and other healthcare providers face daily in order to serve the public
needs for healthcare and all it encompasses.
Why are these compromising issues not being addressed by those who have the power, influence, and status to resolve these issues? The same is true for dentists and other
professional health care providers.
These are my ideas about solutions to this perpetual stigma against
the medical profession:
1. Volunteers: Out of all the incredible depth of individuals with the ability and talents to
teach business principles and knowledge to medical students, why isn't there, among them, those who volunteer their time, energy, and abilities to serve a greater need? It could be
another retired doctor, wealthy entrepreneur, professional business person, or a motivated business school professor near the medical school who recognize the missing link and want
to do something about it.
An organized group of inspired volunteers could provide a persistent and consistent flow of business education to medical students, even alumni doctors in practice. Perhaps this class
of volunteers isn't aware of the business knowledge deficiency among doctors, which would
be hard to believe. Maybe it just takes someone to ask them, make them aware of the seriousness of the problem of physician attrition today and the causes, or tell them how
they could help with these tasks.
It's my impression that people have to know that a problem exists and the consequences of
the problem before they think about volunteering for anything.
2. Donors: When it comes to the issue of money and supporting funds necessary to pay for
the teaching of business to medical students, this perpetuating need falls to a low priority position for reasons of... what good would it do? Priorities usually are to build new school buildings, do more clinical research, and keep up with the other schools in competition for government funding.
Everyone knows nothing can be done without money. Even single donors, donate millions of dollars to medical schools for all sorts of purposes. It seems that finding donors who recognize the incredible medical career business compromising issues, isn't possible. I propose that informational campaigns could be run to let potential donors know about these circumstances. Retired doctors, who financially are secure, would be the ideal candidate and donor because
they have experienced the problems they have had in their practices.
It is quite reasonable that donors could be found to financially support a structure for teaching medical students about business and running a medical practice business if donors understood the need and importance of this educational deficiency. It just takes a motivated individual to get the ball rolling.
3. Time availability issue: I'm sick and tired of hearing that there is no time left in the
medical school curriculum to teach medical students business strategies, not even the basics. There's always time available for important issues. A 142 medical schools in the United States don't consider business education of medical students important enough, and don't have the funds to pay for such education... so they claim.
We are told, correctly, that medical schools have such an overwhelming amount of medical knowledge to teach medical students today that they can't even find time to teach it all to them... and never will. How does one squeeze into the curriculum an education about small business under these conditions? Good question. Let me respond.
First, when all the apples won't fit into the basket, what do you do? You either sort out the bruised apples to make room for the perfect ones or you place the remaining apples in another container.....right? Maybe, medical students are learning far to much medical information,
which they will never ever use in their medical practice. Cutting out the "good to know but
will never use" stuff, would then allow time to learn about running a medical practice
business. This idea brings up several unsettling factors to consider.
Most important to my mind is how would all that be accomplished.
Need to prepare students to make a definite medical career choice early.
Students would then follow a curriculum specific to that career choice.
Any medical knowledge that was not pertinent to the career choice
Add another year to the medical schools curriculum of admit them
after 3 college years... maybe. (My choice would be the latter)
Second, going to the next alternative for making the time to teach business to students and
not disrupting the curriculum profile already established, would be to create a separate curriculum for students to learn about business management and systems. A separate set of lectures would not be difficult to construct. The lectures would be scheduled at times outside
the standard curriculum for medical students who were available at the time.
Attendance could be made mandatory or voluntary (best if it was voluntary). The series of live business lectures would be continuously recycled so that if a student missed one, he or she
could pick it up in the next round. Even better, the live lectures could easily be video
recorded on DVDs, and made available to students to view and review on their own time. Live lectures have several advantages such as a Q and A session, additional tips not mentioned on
a DVD, and private questions asked of the speaker.
Surrounding most of the medical schools are usually business schools in the same complex. Perhaps the advanced business students would volunteer to give business education lectures
for extra training, for credits, for personal satisfaction of filling a need. Also, they might create the business lecture series on DVDs as well under the supervision of instructors.
As is often the case, students who attend a lecture or course voluntarily that they consider important creates a competitive atmosphere among the other students. Other students believe the students who attend a medical school supported lecture voluntarily leaves them behind,
and are then mentally coerced into attending also.
These live business lectures could be arranged in early evenings, noon hours, or early
mornings before the medical duties are begun... even on weekends.
4. Attendance: Presently, medical schools do not indicate to medical students that any
business knowledge about how to run a medical practice is needed, if it's even mentioned
at all. It leaves the students with the idea that they will never need knowledge about running a business... and like a dream, it all will go well in their practice. If you are one who believes that the overwhelming frustration of doctors in practice today is not at all related to their financial (practice income) problems, you haven't been in private medical practice or are financially independent.
Therefore, it would be important to let the medical students know how important it is to have
the business information and knowledge, since the medical school and instructors do not. A
good example of the importance of business education can be made in the case of a
graduating medical student with an average of $150,000 educational debt. For young doctors starting private medical practice, paying for the practice expenses as well as the educational debt, may shock them into the awareness and need for a business system.
Even then, they can obtain the business knowledge, but not anywhere as simple as it was
while in medical school. That's where it should have been grabbed and should be taught.
Result........graduating doctors are half educated for their career in medical practice. They
don't know what they don't know. It's possible they don't want to know. Any level headed
and intelligent physician must understand that they could do lots more in their medical
practice career with a foundational business management knowledge.
My belief is, like the issue of "too big to fail", that the medical profession is going through a major transformation as a direct consequence of lack of a strong business education for all doctors. It has been neglected too long and the need for business knowledge has become embedded too deeply into doctors minds that they don't need it, to allow any recovery of the profession back to any resemblance of the way it used to be.
It doesn't mean that the medical profession will disappear, only that non-physicians will carry the load of healthcare. I think doctors will drift slowly into social and medical obscurity, but
those who remain will still do the hard stuff in medical care from their primarily administrative positions. Yes, the quality and quantity of medical care will decrease. Patients will be
demanding more from the healthcare providers and not getting it, which is the perfect
situation for increased medical malpractice litigation.
The one bright side seems to be the entrepreneurial attitudes of doctors. Creativeness, desire
to make things better, and the personal need to help all mankind continue to lead to
solutions in healthcare that haven't even been thought of yet. When the present surge of
interest in concierge medical practice runs its course, what's next?
The gauntlet of medical practice must include business trained doctors and health care
providers who are in private practice. The exception that seems obvious to me is that at any place in time there are those doctors who leave the managed care systems for private
practice, and even they are not off the hook for small business education.
"Discipline Determines Your Destiny"
It seems to me...........
During the last 8 years or so, while I've been totally involved in business and marketing issues, I have repeatedly run into references by the experts relating to the topic I'm about to talk about today. You make the disciplinary rules you want to live by to accomplish what you want in your life. So why do we fail to follow the rules we establish, change the rules so often, and never quite understand why things aren't working out as expected?
It's quite a lot more complex than simply seeing the logic and sensibleness of creating our own rules of behavior that benefit us. The value of discipline in our lives takes on a far greater importance after we have experienced the difficulties of not having limitations or rules to follow, or at least seeing the results of what happens to others who have no rules for their behavior.
Discipline we construct for ourselves has to be learned and practiced. Beyond that, discipline must be applied to every aspect of our lives in order to provide ourselves with the tools necessary to reach the ultimate highest level of our careers, talents, skills, and potentials. Think about why so many physicians do so much better in their careers than most others. Most have comparable levels of intelligence and skills related to medical practice, yet seem to do so much better financially and reputation wise, even from the same medical school class. Discipline used to it's maximum is the answer.
The secret to success at work and personal potential is the product of discipline. You are guided by the disciplines that result in the most advantages and opportunities. Successful people normally set their professional goals, then establish the disciplines to follow to get there, while disregarding the less important, time wasting, energy destroying, and side ventures, which don't contribute to the performance goals.
Definition of discipline: an activity, training, exercise, or regimen that develops or improves a skill. Ultimately, where we go from there, how successful we become, how much money we make, and how happy we become is totally dependent on
I must have slept through that "discipline" class at school. Like a lot of young people, I did have a good idea what I wanted to do in life, but at that time I had no idea if I had the patience, skills, talents, or determination to make it happen. I thought I'd take a shot at getting into medical school and, if that was not possible, I'd go into chemical engineering.
Desire can't do anything for our destiny, career, goals, or ambitions. Desire and ambition fade with time into procrastination and regret. Desire may be the match that ignited taking action, but the discipline we structure ourselves keeps it burning. Then, it becomes a matter of degree and persistence of the discipline we keep to reach
Discipline and the Holy Spirit within us enables our strength for such things as:
2. Making the right decisions
3. Creating opportunities that otherwise won't be there
4. Setting and attaining goals
5. Accomplishing almost anything you desire
6. Makes for an orderly life
7. Permits access to levels of respect and integrity
Why discipline is so important:
Without discipline, we accomplish nothing in our lives. Without it everything becomes spontaneous, unpredictable, and unreliable.
The enemies of discipline are our environment, our natural desires (mixed good and evil), and needs of our flesh. We are constantly pulled in all directions by our peers, family, bad advice, turmoil, stress, fear, and passion. Natural desires and instincts confuse us, make us vulnerable, and surge into our minds at the worst of moments. Our bodies require food, water, and shelter. Even more important is self-discipline of our thoughts and mind.
Discipline is a choice, not required, and is effective only when applied. Because of the free-will we have been given, discipline runs contrary to it and requires adding it to our lives a batch at a time. To keep discipline and order in our lives it takes practice using it in a persistent manner.
Discipline and self-control have significant rewards:
(These have nothing to do with your medical skills and talents)
You develop character and are a better person.
You make the right choices more often.
You are more respected and responsible.
Others trust you more.
Opportunities become more prevalent.
You will be healthier and happier.
You are more dependable, reliable, and productive.
Life is less stressful and more determined.
Critical use of your time is top priority.
Goals are reachable--short or long term.
You are much more selective of friends and associates.
You impact others around you.
When you program discipline into your life, what you value the most becomes evident. The greatest difficulty is sticking to the program. It's not easy. You just keep restarting over and over until it becomes a habit pattern.
The value you place on you selected path is determined by your diligence. If the value you place on being the best doctor in your city is very important to you, your diligence in keeping on the right track will be extreme. Your diligence is fueled by the Spirit inside you and the passion you feel. You can't have one without the other.
I can't help but think about how much more I could have done in my professional life if I had been taught, or learned, early-on the value of setting goals, the effects that discipline could have had on my college and medical career, and the importance of good career advice that was non-existent at the time. These elements are found as part of every successful person I have ever met, no matter what business they were in, career path, or personal goals they selected.
It seems likely that I did have some of those elements at the time, perhaps unconsciously working for me and still do. It's sad that these things are not spoon-fed to children and reinforced in high school today. Schools teach "getting by" and not "success." However, it all boils down to the fact that every person is responsible for their life, starting in adulthood. That doesn't detract from the responsibility of parents to inspire them, and make them aware of these essentials whether they understand them at the time or not.
The greatest challenge I believe is to get beyond the issue of, "You don't know what you don't know."
Word Count = 1089
"Professional Medical Ethics And The Biblical Forces Of
Force yourself to maintain your personal integrity.
In the throws of desperation it is impossible to know what a person or medical professional is willing to do, how far they are willing to go to reach or maintain a professional level of accomplishment in spite of the legal, moral, or ethical consequences.
After one has practiced in their profession long enough, you come into contact with examples of professionals who have gone astray personally or professionally for many reasons. It is heart breaking to see what can happen to a professional who reaches a point of personal desperation that forces them to compromise themselves and their professional career as a means of relieving their desperation.
A high school friend of mine became a medical doctor, came back to practice in our small home town as a primary care doctor, and within a few years became addicted to drugs. The medical board made him undergo drug rehab and serve in the nearby hospital under the watchful eyes of his peers for a prolonged period of time. I lost track of him after that. He never returned to our town. In a sense he betrayed the people and friends he grew up with, his patients, and the town that respected and trusted him.
Another close doctor friend of mine with a great sense of humor that made others like him for his congeniality, gave up his practice out of desperation. Behind his cheerful personality was a mindset about medical practice that became so dominant in his thinking that he had to take on a life of locum tenans bouncing here and there around the country. During the years I worked with him, it was clear that he had mentally structured a rigid set of medical practice rules to live by, which he would never break. It eventually led to the failure of his practice, compromise of his family, and left him a lonely person.
I believe that I was one of those physicians who reached a point of desperation in my own medical practice. My marriage fell apart over time and my episodes of mental depression as a result of PTSD in combat in Vietnam kept me on the verge of suicide for many years. A single malpractice suit resulted in me being blackballed nationwide by every malpractice insurer who refused to cover me for Obstetrics led to failure of my medical practice financially. Gyn practice only would never sustain me in practice.
It became necessary to give up my state medical license as a result of the one lawsuit so I interviewed for hospital and clinic positions across the USA where I would have malpractice coverage because the insurance was not obtainable for me in private practice anywhere. Several other states where I already had unrestricted medical licenses then terminated my medical licenses, essentially leaving me with no career or profession.
Eventually, I was hired to work in a Women's Clinic of a hospital where they were not able to keep doctors they had hired before me. My job there rescued me, kept me in the profession, and went well because they were able to get malpractice insurance for my full ob-gyn privileges. It went well there for me as an employee doctor.
As you can surmise, I had a great deal of stress while I continued to run my practice in a very professional and ethical manner.
There were two primary factors that actually destroyed my career--one malpractice suit where I made a bad judgment in OB (in my 30 plus years I had 4 actionable suits, 3 settled, 1 trial that I won). In California at the time an OBG doctor averaged one suit every 3 years. The second reason was the inability to get malpractice coverage for OB.
In spite of all the circumstances I was at the top of my specialty by all standards until the one malpractice lawsuit that settled out of court and killed me. I can only say that as a physician in practice for the first 23 years I never had a problem with licensure, medical boards, criminal offenses, staff privileges, or unethical practice methods.
Now that I've revealed all of my many faults, even though they are all public record, it may make the tabloids happy and give them something to do. The punishment for my frailties still goes on today in one way or another.
Let me be clear. I expose myself to you not for pity, or sympathy, but to point out to you that there are good reasons to have multiple streams of income. You need to get those going very early in your medical career and continue them. With medical practice being pelted today and in such a sever manner, it should be a wake-up-call to you to consider the future probabilities of your remaining in the profession as time goes on.
My greatest concerns about desperate physicians:
After investing so much money and time in education, a professional career, and your effort to live the life you deserve after all that effort, you certainly don't want to lose what you've gained.
I can see now that the desperation physicians feel regarding their practice and profession has been greatly enhanced by never being taught how to relieve that pressure and worry with good business systems and marketing strategies. Doctors have no place to hide, no place to run to, no place for help without costing huge amounts of money. It behooves a physician to get the business knowledge and training whatever the price. In the long run, you win the race.
Some published reports about unethical procedures or testing that can ruin a medical practice and career:
1. Overcharging for services rendered.
2. Charging for services not rendered.
3. Performing procedures that are medically not indicated.
4. Kickbacks of fees for referrals.
5. Performing procedures you are not trained to do.
6. Selling drugs to patients or over prescribing narcotics.
7. Scheduling follow-up visits that aren't necessary.
8. Spreading one appointment and medical problem into
9. Piling on charges by billing for services or supplies that
are usually part of you overhead costs.
10. Billing for phone consults with patients without exams.
11. Attaching fees for incidental supplies and free drug samples.
12. Cheating on business write-offs, travel expenses for
13. In-office pharmacy business--buy meds wholesale for
sale retail to patients.
14. Charging for procedures like unapproved diagnostic
I'm sure that you can add many more to this list. I know that when any medical doctor or health care professional has a sound education in business and marketing there will be no reason to go to such extremes to make more money, prevent burnout, pay for college for their kids, fund your retirement plan, and etc. Because you will have the ability to earn money the same way a successful retail store owner makes his money without having to stretch or break the laws and put yourself in jeopardy.
My new ebook available now, contains all the information you need to create your financial empire by doing it yourself.
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"Choose your poison--medical practice is rapidly changing to a place where you haven't been"
It seems to me..................
In a very short period of time ahead the medical profession will become comprised of two medical practice categories--physician employees and Concierge physicians. When the Medicare medical fee restrictions and regulations drop another 10%, I believe that the other 60% of physician holdouts that still continue to treat Medicare patients will have to stop their coverage of Medicare patients altogether. Treating those patients will reach a point where Medicare patients are being treated for free, and doctors are subsidizing their medical care while severely compromising their practice income enough to lose their practices.
Private medical practice as we know it now, won't exist. Private health care insurers will not be able financially to sustain coverage even for private patients. It's likely that health care insurers will convert to other insurance to remain solvent. This row of dominos is well on the way to flat-lining.
Even the most prestigious marketing and business experts are now looking at the health care industry economics and are prognosticating the rapid rise of "cash only" medical practices (Dan Kennedy being the most vocal about that). My suspicion is that most of the physicians will procrastinate on performing any practice changes until they are forced by decreasing incomes to convert to one of the Concierge models of practice. Probably, they will follow the practice structures of plastic surgeons who are essentially in cash only practices now.
In my view, with the persistence of the frustrations physicians are now demonstrating about their practices will reach a tipping point where they will become burnt-out fighting the health care system and give up the medical ghost. To my mind that means instead of physicians modifying their present practices to comply with the economic circumstances, fee restrictions, governmental control, and legal environment, physicians will completely change their medical practice, move if necessary, convert to a Concierge model at the blink of an eye. Using a little logic, it's not hard to recognize that the act of complying and modifying their practices will continue to be necessary over and over again.
It's far easier and much more sensible to completely transform their practices to a cash only basis at the start. Clearly, the restrictions will never be reduced and probably continue to increase over time. The best time to do the transformation is now, not later when hundreds of doctors are doing it at the same time.
The flourishing Concierge practices at the present time are group practices composed of several concierge minded physicians with the same goals. A single specialty group would seem to be the most financially advantageous for doctors. Doctors will share the overhead, equipment, and personnel thereby avoiding the very slow growth of most solo concierge practices that must forage for income the first few years of the practice.
Multi-specialty concierge medical groups certainly will do well, especially with cross referrals to each other. Patients love to have all their doctors in the same place, same building, same office complex. Other than sharing equipment and overhead costs, the most beneficial aspect of this model of practice are the internal referrals of patients.
Because cash only solo practices must be located in an affluent area to begin with, it restricts choices of where to set up a medical practice, and requires a great deal of research to find the best sites, free of competition, and with a large affluent population.
In the case of multi-specialty groups, they have many more choices of practice locations because they need a full age-range of patients to work with, but yet have to have money enough to contract with the concierge group for their care.
Both solo and multi-specialty concierge groups have a major disadvantage in that referral of patients from the local doctors to them is very uncommon. Patients with health insurance seeing a local doctor may very well find their private health insurance costs rising to the point where it is not affordable. These patients, if they have jobs, may have access to HMO's for their care. However, patients my find that the cost of contracting directly with a concierge private doctor group likely will end up being a fraction of what other health insurance carriers are charging, including the HMO
The concierge medical practice system is expanding rapidly. The systems have been tested on many fronts and in many areas of the USA. People are already drawn to the system and like the services provided them that are way beyond those of our standard health care systems, even private practice.
When you as a physician look carefully at the concierge system of practice, you may be quite surprised at advantages gained by all these physicians. The standard concierge solo practice carry about 300 to 500 patients compared with 3000 found in the usual medical practice. When you multiply the approximately $2,000 per year charge per person for all their medical care for the year by just 300 patients, the gross $600,000 you earn is paid ahead and goes to your practice bank account instead of the health insurance company's.
It's much easier to convert your own medical practice patients you already care for over to a cash only practice, because they trust you. It can be done slowly as you present your patients with the options and advantages of a concierge system, that most patients have no knowledge about.
I advise all practicing physicians to seriously consider a concierge medical practice.
"The Increasing Pressure To Eliminate Private Medical Practice"
It seems to me................
......there's no end to what our government is willing to do to terminate private medical practice. The recent blurb in the recent Wall Street Journal again points out how the new health care law intends to force the coordination of what hospitals and doctors do. The new organization is named ACO (Accountable-Care Organizations).........like we need
This new system and business is there to prevent the duplication of medical tests among doctors and hospitals to reduce the costs of Medicare. They seem to have forgotten that EMR (Electronic Medical Records) has already been mandated by law for implementation in medical care offices soon, which will and can eliminate the need for any ACOs, in my view. By simply clicking on the EMR one can see the tests already done and not reorder them.
The most frustrating part of what the political medical masochists have not considered as worthy of attention, are the massive problems other countries in Europe and in Canada, among others, have had with their socialized medical programs, especially the fact that the availability of medical care to patients is significantly reduced through restrictive rules that intentionally limit medical care (rationing) to certain segments of the population. True especially, where it costs the system too much money to care for unproductive people and those with terminal diseases--just left to rot.
When countries are going bankrupt, it adds an even bigger problem--no medical care available at all, at least some times.
During my meditation times, the last 20 minutes I'm sitting on the toilet, I can think of many ways in which the presence of private practice medical doctors are in a position to provide health care to patients even if the whole government collapses. Does it make you wonder if the national health services in those countries permit their contracted doctors to provide care to anyone that needs medical care, or just to those who are members of the organization? It follows, when 95% of doctors are locked to the national health systems and it fails, where do all the patients go for care?
Patients who are left with choices of who they prefer to have manage their medical care are at a great advantage far and above those cornered in any form of national health systems. The circle of dictation of medical care to patients started by doctors telling patients exactly what was to be done in the old days, switched to dumping medical care choices on patient's shoulders while doctors waited for the patient to decide era, and now is back to the government doing the dictating to patients as well as doctors.
No one denies that the best medical care happens in a private medical practice office, except for the idiots who always have a ulterior selfish motive in mind.
One last comment about what seems blatantly obvious to me. For my about 50 years in medical circles and exposed to about every kind of medical practice and delivery of health care one can think of during that time, I keep hoping that organized medicine at its highest levels would be able to save the profession from the clutches of government. I am sure it can't. All of the lobbying by the proponents of maintaining private medical practice are not able to change the minds of politicians. Its for the same reasons we see now that ruling by consensus opinion has eliminated reasoning and the power to change anything. It's no different than what you experience in hospital staff committees.
It might be a very good idea to cinch up your suspenders, hope that Dec. 21, 2012 will have a positive effect on everything, and stand up for what you believe. And, if that is not enough, I have some other ideas for you to think about.
"About the dumb teaching the dumb about business"
It seems to me................
......that business and marketing training for medical doctors and other healthcare professionals is a non-issue even in the postgraduate arena. Wouldn't you love to go to a medical professional conference at least one time in your life when the focus of that meeting was strictly on the business of medical practice? At least once to have an experience where a single critical aspect of medical practice success is finally taken seriously by the medical profession itself.
I happened to notice in my college newsletter (ACOG) in Mar. 2011 that a Junior Fellow ACM course was to be taught to doctors transitioning from residency to practice. I was delighted to see that one of the speakers was giving a presentation about the business of medicine. Being curious about what background Scott D. Hayworth, M.D. might have for this important topic, in light of the fact that medical schools could care less about teaching medical students, I Googled him on the net. Although there were more than a bunch of search engine listings about him, I found that he had no background education concerning business or marketing--only personal experience.
So, once again I see a medical doctor teaching other doctors who apparently has the same knowledge about business and marketing as the audience does---indicating to me again that this education topic about the business of medical practice is unimportant in the eyes of the medical hierarchy. Beyond that, whoever offered him the lecture topic on business must have had the same impression about the value of the topic. That is....unless they couldn't find anyone else willing to give a talk about business who was seriously qualified to do so. Could it be that the committee didn't have enough money to afford a highly qualified person to give the lecture?
When I faced the exact same situation coming out of my residency with my family and ready to start my practice and almost broke, it would have been the perfect time for some expert on business to have dumped all their information and knowledge on me. It certainly would have made a huge difference to me about what I would do next.
In our present economic environment, another transitioning phase has evolved following the end of the training phase, which affects all new physicians. Judging from the educational debt on the shoulders of new doctors, it's quite obvious they would not have enough money to start a private practice, unless they were independently wealthy, or had a rich uncle. It forces new doctors to become an employee for 5 or 6 years to save up enough money to start private practice. I'm not saying that's bad, but it certainly delays any medical practice dreams, goals, and expectations a young doctor might have, while managing the other aspects of life, family, and politics.
Combine all the above with the lack of legal caps on malpractice verdicts, increasing fee restrictions by the government, a rapidly decreasing respect for physicians and their status, and having to live in a low middle class lifestyle and you have every reason for being terribly disappointed with the profession.
My conviction is that a great deal of these stresses, barriers, and millstones around the neck can be relieved only by having a sound knowledge of business and a working knowledge of marketing at the very least---or by Dec. 21, 2012.
Although I will continue to bang my head against the "walls of tradition and dogma", I still get great satisfaction in knowing I may have made a little difference in a few individuals along the way, and maybe, somehow, someone will pay attention to my preaching and finally do something about it. If I had 5 million dollars, I certainly would be shaking up a few heads.
"About medical practice marketing needs that are often not met
and reasons why"
It seems to me................
......medical practice professionals and healthcare providers who are in their own businesses are feeling the overpowering economic tsunami threat taking place everywhere, biting fingernails and probably praying a little more than usual, while sensing their own vulnerabilities to being able to protect their careers, professions, and businesses. That said, I can assure you there are thousands of brilliant people out there who are willing and able to share their knowledge with you and help you rise out your business hopelessness that has infiltrated to some degree every professional's mind.
A few days ago I had an opportunity to strike up a conversation with a second year medical resident while he was observing the practice activities of an endocrinologist. The process of choosing a place to practice had him confused. I could sense his frustration, but it was also obvious from his comments that he felt he had started thinking about a place to practice way too late. Not only had he never researched various places, cities, regions, or opportunities to any significant extent, but also appeared not to be very worried.
His pleasant attitude to my questions indicated he was comfortable with the concept that "I can practice anywhere" I choose. Clearly, he was being held in bondage to the outdated and traditional medical practice attitude that medicine is an art and not a business.
Further questioning confirmed what I have repeatedly been saying about the deficiencies of medical education--the lack of any business or marketing training necessary to succeed. Nowhere in his educational process, he admitted, had anyone indicated the need to have or to get that knowledge. He did understand that he should have that expertise, but had no idea how to get it in the middle of his education process. I cringe every time I see an example of another young doctor being educationally crippled by lack of business and marketing education.
Who, besides me, has taken on the challenge of correcting that deficiency? The rationalization I hear so often from those who could take a stand is the usual stuff. Doctors should hire some business and marketing experts to do it for them. The ridiculousness, even laughable nature, of that thought is so often refuted by the financial compromises doctors are being forced into. Major numbers of doctors and other professional health care providers aren't making enough money to afford to hire experts to help them in their business. Either way they lose.
If our world remains intact, and if the medical profession remains important (I often think that it isn't) in the near future, the only direct means of fixing the business and marketing knowledge problem is to have the professionals do it on their own.
Convincing medical professionals that the knowledge is necessary
Persuading physicians and other providers that their maximum potential in their career can only be obtained through the use of documented business and marketing strategies.
Providing them with the materials to learn the strategies.
Introducing them to creative ideas about what can be done with those materials.
Showing them the systems to use to increase productivity.
Giving guidance how to manage their business effectively and convincing them to do it right.
Showing them that business and marketing systems improve income a thousand percent.
Unsticking them from the traditional mindset of not needing these factors.
Promoting step-by-step blueprints for creating each modality.
February 2011 --
"About business systems and their value"
It seems to me................
......that I should be paying more attention to the very specific things that you are hungry for. Last week I exchanged emails with a subscriber to my newsletter which set me to thinking about going back and completing a project I had placed on the back burner. This businessman had actually taken the time to send me an email thanking me for the information I have been providing in my newsletter. It wasn't so much about getting a pat on the back, but much more about what I discovered during our exchange of emails.
He's in a business of consulting with physicians, other health care providers, and hospitals regarding billing systems and collections. During those sales and repair problem visits, he admits being asked repeatedly about the medical businesses need for information how to market their business in this tough economic time. What he felt was needed by these medical businesses was not video tutorials, referrals to websites, or a book to read on how to run their marketing or business projects. They just need something easy and simple like a 3-ring binder where they can flip the pages to the spot they need info about, and read down the list of steps about how to set up a system and maintain the process indefinitely.
From my personal view, that binder would have to be expanded to a dozen binders, and cover the hundreds of pages necessary to adequately provide the following necessary items:
the setup instructions
step by step process
barriers and problems to avoid or overcome
reasons for doing each step a certain way
timing of each step and why it's needed
descriptions of how each step meshes with the business as a whole
segment assigned to teaching new employees the processes
and many other associated features to make it all work
The reason that it would be such a multiple binder project is that the information would have to be presented in an easily understandable format, worded and described in such a way that any office business employee would be able to pick it up and promptly understand what it tells them to do, understand how to do it, and understand the reasons why. In general, copywriting of most advertising and marketing promotions has to be worded for about a 5th grade level of education. And that, my friends, is probably why the idea has been on a back burner for so long now.
However, as is often true of entrepreneurs, that sudden spark of creativeness jolted me out of my comfort zone leaving my shoes behind. We learn that the word "impossible" has several different meanings depending on the degree of inspiration one is fired up with. For those whose feet are nailed to the floor, it means no one can do anything about it. For those who are watchers, it means that they intend to hang around awhile because someone might be able to actually find a way around the impossible thing, and they want to be there when it happens and they they'll know how to handle it as well.
For entrepreneurs, it means that regardless of the perceived difficulty that might be involved, "impossible" amounts to a virtual hologram that one can walk right through--when one finds a way to get past it. That thought put me in a mindset that, creating the binder and the data can be done not as a compulsive person would do it, but, by the way a practical minded person would do it and save a lot of paper and ink. Compulsive perfection for doing projects is a definite handicap.
I have learned about business, projects, marketing, and any other life work that it is a complete waste of time trying to make everything perfect before you try it or sell it. Presenting a lousy speech which has excellent value to the listeners is much better than the opposite. There's a lot of substantial body of evidence why we should only shoot for "good enough."
Evidence why "good enough" works:
1. If I created a 1,000 page marketing "starter file" which anyone could read and understand, likely no one would attempt to read it or even use it. If it's 1,000 pages, the perception is that it is way too complicated to be understood, without ever trying to read a section of it.
2. No matter how much you seek perfection in what you do, there will always be glitches, unexpected external intrusions, things left out or not consciously considered, things that have to be changed or modified, and supernatural ghosts who keep drinking from your coffee cup.
3. Imagine for a minute what Michelangelo could have accomplished in his painting if he had not been such a perfectionist. Compare his work with that of Van Gough, who smeared gobs of paint on the canvas until he thought it was good enough. Is one better than the other?
4. Because doctors and healthcare providers are in reality selling their expertise to their patients, it is reasonable that in order to see more patients and make more money, they have to reduce their sales pitch to a "good enough" level with patients. So, how do we decide on what's "good enough?" I didn't know it at the time, but my intent to explain things in depth, answer all questions, and enlighten all patients as my way of doing a good job in my practice burnt a huge hole in my bank account for years. I should have been tied up and whipped for that ignorance.
My decision--I'll create a binder doctors and their employees can use for marketing planning and promoting their medical practice business. I'll make the time to do it, even if I'll miss my daily back scratch.
Tell me what you think about all this!
What do you need in your medical business? Don't be a pansy---tell all!
January 2011 --
"About medical practice management"
It seems to me................
After reading a recent article about business management and the difficulties that business administrators have in doing their jobs, I immediately could visualize the close connection to
why most physicians not only have difficulty with the administration of their own medical practice business, but also why all professional medical providers are victims of their
It's well recognized and accepted that entrepreneurs make lousy managers and administrators. Medical doctors are, by definition, entrepreneurs. It would be difficult to
argue against that premise because doctors function in the same environment, or world, as all entrepreneurs. Almost every patient comes to the physician with a symptom, or complaint, or medical problem that may not present an easily recognizable pattern of a disease or diagnosis. So, here in the first minute of speaking with his patient, doctors find themselves outside their comfort zone and involved in mental creativity.
The doctor can then open their mind to all kinds of possibilities for diagnosing the problem
as well as possible treatments, all of which are subliminally squeezed out of the memory
banks by the subconscious mind. From there, the search becomes more focused, and the possibilities are narrowed down. The whole pile of information and findings are funneled down
to the most obvious cause which usually has a most common treatment. If that's not the case, the doctor ends up in entrepreneur heaven with bundles of ideas and a great opportunity to
solve the problem anyway, and show the world what they're made of--perhaps even the elite medical school they graduated from.
Getting back to those attributes I mentioned above, several are those that are a real pain
in the ass for those doctors in private practice who avoid taking full control of their office business, avoid the responsibility for management of their medical business, and avoid attempting to learn and implement time proven business principles every physician must have for maximizing their own potential in practice, but also the highest potential for their business income and efficiency. For doctors in this hypnotic state of avoidance, the inevitable consequences always show up, often, when it's too late to do much about their circumstances.
The crime is that it should never happen to any physician when it is entirely preventable.
Probably, the greatest distaste for management to a physician is that too much of the administrative work is either too routine, or not challenging enough to peak their interest. You know that the worst thing that can happen to you in medical practice is to have two jobs at the same time. In one you are your own employee working for that invisible corporation you set
up to run the practice business. The other is being the owner and CEO of the business which requires management of the business done by the only person responsible for the success of
the business... you!
Pushing the management job on to an untrained employee who thinks she or he can handle the job is downright stupidity. As the old saying goes, "Ignorance can be overcome by education, but stupidity lasts forever." Hiring a person trained in management, dramatically improves the office business functioning, but does not remove your overall responsibility for supervising the manager and maintaining your control of every aspect of your medical practice business. Managers earn higher salaries, so you must earn more to pay them, which is often a problem for physicians nowadays.
Another trait doctors have that makes it difficult to manage their office is difficulty in delegating duties. Most doctors want things done a certain way. They often are not satisfied with how someone else does a job and would much rather do it themselves and have it done "right." A mistake made by the majority of doctors who do delegate duties to their staff is that of not taking the time to explain to the employee exactly what he wants done in detail. If it's done without a detailed explanation, you will get back what the person thinks you may have meant.
Delegation of duties, including outsourcing, is a critical issue for business growth.
Physicians must learn to be satisfied with, "good enough" work done by others. No one can
do it all themselves.
The distasteful idea of replacing yourself, your importance, your supreme talents, makes a huge dent in the ego and self esteem, which is another barrier to good management
We all develop habit patterns in our lives to make our life experiences easier and quicker.
It's been reported that 80% of our daily activities are composed of habit patterns. For
doctors, it's just another problem in their adjustment to a managerial status, where most everything in management is constantly changing, new problems, new innovations, new procedures, new employees, new systems, new toys, etc.
If there is one essential factor to keep in mind while thinking through all of this stuff, it's
one that's known to all success business people, business experts, management experts, and maybe even your wife or husband.
You need to make your productive time even more important than it is now. You must
free up the time to do the $100/hr. job instead of doing the $10/hr. job. It's very easy to
find an employee to work for $10/hour but you rarely can find an employee capable of doing what the $100/hour requires. That, is what you must do yourself, no one else can do it. In
most medical practices that job is marketing your medical practice and establishing a constant flow of new patients into your practice.
How to weasel out the time to do the management process for your practice business will be
one of my articles soon to come.
Curt Graham, M.D.
2404 Mason Ave. Las Vegas, NV 89102
E-mail = cgmdrx(at)gmail.com
© 2004 - 2015 Curtis Graham, M.D., All Rights Reserved.