And the winner is… Dr. Bobb!

In the contest to describe a goal and a plan to meet that goal for a medical practice, Dr. Bobb is the winner (and the ONLY contestant!)!  Now, I don’t know exactly how well his plan will work, but I’m loving the idea of the vacuum.   He notes that they will take turns cleaning the bathroom.  Hmmm, we’ll see how that works out!  Visit his blog for more fun!

Here is his plan for his practice:

The Goal:
Cut nearly $5000 a year from the practice’s operating expenses.

The Method:
Terminate the practice’s contract with its janitorial service.

The Timeline:
As soon as current janitorial service contract is up, sooner if it is an “at will” contract.

The Plan:
Purchase an iRobot Roomba to vacuum the office building’s carpeted surfaces and a Scooba to clean the tiled floor areas. Cost: about $370.
Office staff will take turns cleaning the office’s bathrooms.

The Personnel:
Office Manager will purchase the cleaning robots. All office staff (including the doctor) will take part in keeping the office clean.

Dr. Bobb is the recipient of  a $15.00 Amazon gift card from PookieMD.  Don’t spend it all at once, and keep us posted, Dr. Bobb!


Medical Practice as a Socially Responsible Business

I have searched for a way to describe my view of medicine as a business.  I finally realized that the practice of medicine should be classified as a socially responsible business.   “Who cares?”, you say.  Well, I say we all should care.  We went into medicine to help people.  However, as I am fond of saying, we can’t help people if we don’t keep the doors open.  We need to have a way to do both.

So how to reconcile the two visions?  We have the altruistic Norman Rockwell picture of the benevolent physician examining a young girl’s doll directly opposing today’s appointment packed, hyper regulated, law suit filled world.  I propose we view our practices as socially responsible businesses.  So what does this mean?

  1. Owners of socially responsible businesses realize that making money is important.  Practices need to stay in business, pay their employees a competitive wage and make a decent living for the physician owners.
  2. Owners of socially responsible businesses realize that as a practice grows, non-financial benefits grow.  You CAN see patients who can’t afford to pay, or can only afford to pay a little if your medical practice/business is financially fit.
  3. Owners of socially responsible businesses realize that non-financial benefits have financial costs.  The socially responsible business may have to absorb higher costs and accept smaller profits.  NOTE: I didn’t say run the business as a charity!  By definition a business is NOT a charity!
  4. The socially responsible businesses/medical practice has at it’s core a mission to provide quality health care AND stay in business.  The two are NOT mutually exclusive, but must intertwine and co-exist.  One must feed the other.
  5. Government intervention and big business are not appropriate business models for socially responsible medical practice/businesses.  Physician owners must start from the ground up and build a profitable, socially responsible business model that DOES NOT involve government intervention.  Additionally, the typical frenzied profit taking by big businesses is not an appropriate model either.
  6. The socially responsible business/medical practice must seek efficiencies where ever possible.  Creativity is a core value of the socially responsible medical practice/business.
  7. The socially responsible business/medical practice avoids “short termism” and “poor governance and regulation, misaligned compensation and incentive systems, lack of transparency, … poor leadership and a dysfunctional business culture.”  (Quote from Al Gore,  This means that the physician owner is in the medical business for the long haul, and has a clear vision as to where the socially responsible medical business/practice should go.  It means the physician must learn HOW businesses operate, and how to manage the practice in a long term sustainable fashion.
  8. The socially responsible business/medical practice behaves as if people and place matter, because they do.
  9. The socially responsible business/medical practice believes that time is money.  Therefore, it doesn’t waste the time of patients or physicians.
  10. The socially responsible business/medical practice embraces technology, but realizes that government mandates to REQUIRE technology will drive the socially responsible medical practice/business OUT of business.

For more resources and thoughts on the socially resonsible business of medicine, see  View the declaration of independence on “b corporations” at:  See also Ode Magazine, December 2008, pages 21-25.)  This issue is not yet available on line, but website is  I have no alliance with the B, or Ode Magazine.

10 Reasons Your Medical Practice is Failing, and How to Fix It

As the ExtraMD, PookieMD has seen lots of practices.  I have also been asked to evaluate failing practices to see where they got off track.  There are some common themes amongst failing practices.  For once, I will NOT carry on about reimbursement, but rather focus on where the physician owners of these failing practices went wrong. Here are my top ten reasons primary care practices fail:

  1. No budget.  With out fail, every time I have asked failing practices about a budget, I get a vague answer, along the lines of, “Well, we look at the numbers.”  NO!  A budget is not something your book keeper or office manager creates, and then places on a dusty shelf!  You need to look at it as a tool, and analyze where your practice’s money is going, where you want your practice to go, and why you are (or are not) getting there.  You must analyze variances and figure out why they are occurring.  When I say you, I mean YOU!  Yes, you must understand this process to guide your practice/business!
  2. Serious lack of planning.  We physicians are masters at trying to anticipate and forecast what happens with patients.  This same skill MUST be applied to cash flow.  You must forecast your cash flow  so you can plan ahead.  Good examples of bad planning: not anticipating paying your staff for holidays/vacations, not planning for the lost revenues while YOU are on vacation, not planning on HOW you will pay your new partner before s/he is generating enough to cover her salary. 
  3. Huge empty offices.  I worked at one office where one exam room was crammed with free give aways from drug reps.  You couldn’t even use the room.  Yup, pens, cute pedometers, plastic clip boards, heart shaped watches were stuffed into the exam room, rendering it unusable.  Yikes!  Who can afford that?
  4. Top heavy staff.  If you are a small office, you really need to examine how much staff you have, and how much your really use and need.
  5. Buying sprees.  Before you invest in what ever new gizmo you think will earn the big dollars, do a thorough market analysis and cash flow projection.  (Worst example I’ve seen: a gazillion dollar laser that a practice bought but never used!)  Don’t just believe what ever a vendor is telling you.
  6. Investing in an EMR and not using it.   I have worked for 4 different practices that bought EMRs and were too busy to a) use them at all b) wrote notes and then typed them in later, c) persistently scanned notes in.  I’m not kidding.  If you are going to get an EMR, commit!  Realize it will take oodles of time to make it useful, but for Pete’s sake, don’t buy it and have it sit there!
  7. Not putting in the hours.  All of the practices I have been asked to review had physicians that felt like they were working quite hard, but were only putting in 6 hours a day.  Many offices would open at 9:00 am, take a 1.5 hour lunch, and then the office would close at 4:30. 
  8. This is not your father’s practice.  Back in the day, the “GP” hung out his shingle, saw 10  patients a day, gave a shot of penicillin in the behind for everything and perscribed milk for ulcers.  If you think the business of medicine is that simple you are in the wrong profession.  Physicians must understand the complexities of today’s medical/legal/business world.
  9. Poor location/top heavy lease.  It’s tantalyzing to have the medical office suite with the fancy furniture and custom wall hangings etc., but get real.  See #1, BUDGET!
  10. No advisors.  We physicians are smart, but not smart enough to know everything.  The practices I have evaluated typically had physician owners that were trying to do everything themselves, with out utilizing advisor such as bookkeepers, accountants and business attorneys.  You must know enough to understand your advisors, but you also need to trust them to guide you.

If you see your practice here, get busy making changes!  Today’s climate is tough, so we need to get tough in how we run our practices businesses.

Physicians Need to Lead Our Country Through the Health Care Crises

Economic times will absolutely mean  big things for the business of medicine.  The amount of insured patients will go down, and the number of uninsured patients will go up.  So what does that mean to us, the primary care docs in the trenches? How do we shore up our economic coast and continue to see patients, which is what we trained for?  The obvious answer is first, to be prepared.  Decide in advance how much “self pay” your practice can afford and have a way patients can set up a payment plan.  Collect copays when they are due, and be prepared to challenge insurance companies to get paid for the work you do.

The bigger questions is: what can we do about health care in the United States? What solutions do YOU have as to providing care for the uninsured/underinsured?  Are your ready to become a leader?  What education do ALL physicians need to ensure we can deliver the care we all want to give?

I encourage all of you to get active in the political and economic climate we are in!  Stand up and make you voice heard!  We as physicians are uniquely qualified to guide our country in supplying appropriate care to our fellow citizens.