geniusWe are not geniuses.  We are not anywhere near at our full potential.  We see so many areas where we could improve.  Yet, for some reason our practice is considered very well-run.  We are frustrated at our shortcomings, but patients are thrilled by our strengths. This afternoon, I walked into the exam room 45 minutes late.  I got a late start when my first few patients didn't get put back until 20 minutes late.  That frustrated me.  Then I got even further behind when my patients kept asking questions and adding problems for me to think about (the nerve of them!).  So when I walked into the exam room and immediately apologized to the woman in the exam room.  I was frustrated.

She paused, then smirked, then said "This is about as fast as I have been seen at any doctor's office.  I usually have to wait almost two hours."

Two hours?  Have you ever a grocery store and had to wait two hours to check out?  Would you wait two hours to get your oil changed?  Would you be impressed if your date showed up two hours late?

Not all doctors are so bad at customer service; but the reputation is definitely well-accepted.  Lawyers and accountants have reception areas, hotels have lobbies, and doctors have waiting rooms.  Is it a coincidence that we call those we care for patients?

So why is it so hard on PCP's to make a living?  They have an incredibly marketable skill - one that is in short supply and highly valued.  Yet few are happy with their income.  Whose fault is this?  Is it the insurance companies'?  Is it the government's?  While I think these entities play an important part in the struggle of the PCP, I think that there is something else.  Why would physicians in my practice be able to earn more than 90% of PCP's?  Is it that we are so good, or that the bar is simply low?

The job of physician requires very little long-term planning.  A doctor thinks very little about the patient when they are not face to face with them.  Decisions are made, the encounter is over, and the doctor goes on to the next room.  Strategy and planning - two things that are very important for business - are really not something most doctors do much of.  When I see a patient, I react to what is in front of me.  I look at the blood pressure, listen to today's story, and make a plan with what I have.  Rarely do I go back and research the best approach to the problem.  Rarely do I spend more than 15 minutes thinking about a specific patient's problem.  It just isn't in the nature of the job.

Running an office is takes a totally different set of skills.  It takes research, planning, consistency, patience, and dedication to a goal to make a successful business.  If you react to every situation that is in front of you in business, you change constantly and never get to a goal.  The payment system in the past was so favorable that doctors could make a good living despite running the business side poorly.

planningfrom www.despair.com

Our practice got lucky.  If I was in charge of our practice, we would be constantly changing and never finishing tasks.  We would have big plans, but get lost in the details.  If my partner were in charge, we would be so stuck in details that we would never even see the goal.  If my other partner was in charge, we would be all about building relationships and avoid tough confrontations necessary to succeed.  Somehow, however, the three of us work in a way that covers the bases.  We trust each other too - which is essential.  I didn't hire the other two physicians because of these traits; it was just good fortune.

So what's the point?  Being smart is not enough if you want to run a business.  Being proactive smart is far more important than being reactive smart.  Being patient and sticking with a task is far more important than being creative and quickly solving problems.  Business problems take a long time to solve, and I really wonder if most doctors have the patience for that.  For the small practice to succeed, doctors need better business skills than ever before.  What it takes, however, is not more book knowledge; it takes knowing your strengths and finding people to help where you are weak.

Can most docs do this?  I have my doubts.

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