Physicians are supposed to treat patients. Cardiologists take care of heart medications. Surgeons operate. Urologists do… what they do. This part is pretty straightforward. When you start that new practice, you expect to take care of patients. Easy, right?
As it turns out, things are not always as simple as they seem. As I’ve mentioned in previous articles, I am currently pursuing my MBA. It’s not because I don’t want to be a physician anymore, as I am often asked. Rather, it was my real-life crash course in marketing that drove me into the business of Business.
When I started my practice, I was expected to do all of the things that vascular surgeons do: aortic aneurysms, limb revascularizations, dialysis access, some veins, some carotid arteries… All pretty standard stuff. And I was fully trained and board-eligible to do all of these things, so I didn’t expect any issues. After two years, however, I was stuck in quicksand — I couldn’t produce the RVUs [essentially “credits” you get for doing different billable things that often determine how much you get paid] to meet the demands of my group. I was dumbfounded. How did this happen? My clinics were relatively busy. I was regularly doing the “meet-and-greet” activities a young physician needed to do to build a referral base. My patients seemed to like me and were willing to listen to my advice. So what was going on?
I increased my number of clinic days. I extended my clinic hours. I was already on call 50% of my life. I even stopped taking vacation that wasn’t related to my upcoming board exam. No luck. My division head was unhappy. I was miserable. I was told multiple times that I needed to work harder to meet my productivity requirements, but I was completely out of ideas as to what more I could legitimately do. Alas, nothing seemed to work…
I started taking a closer look at how I was spending my days. When I was a fellow at our urban tertiary center, productivity was the least of our worries. We had patients and surgeries coming out of our ears. Why was my suburban practice so radically different? Well, for starters, my patients tended to see doctors and take their medications more often than they did in the inner city. When they presented with a problem, it often wasn’t far enough along to warrant an operation. They just needed someone to monitor their issues until the time came when they actually needed an intervention… if ever. Also, I had a significant population of older patients. Many of them came from one of the dozens of nursing facilities in the area and weren’t always in the best of health. In other words, they needed some management, but they weren’t great candidates for any kind of operation. As I looked at my patterns, I realized that my surgery clinics were filled with patients who really didn’t need a surgery.
Stop Reinventing The Wheel!
I also noticed that certain types of patients kept showing up in my office. In my part of town, we really didn’t see a lot of hemodialysis patients. Veins, on the other hand, were aplenty. Chronic leg ulcers also kept popping up on a regular basis. This was a very different emphasis than what I had experienced at our urban hub during my training. Slowly, I began to shift my focus to accommodate my community’s demand. I would still see the occasional dialysis or aortic patient; however, I worked with my local team to develop our vein program and to market our center at local events so we could spread the word. Over the following two years, our vein practice grew rapidly. We then worked with our community hospital leaders to start a wound care center just down the hallway from our regular practice. It’s booming! The demand for wound care services in our area is even bigger than we had anticipated. We continue our regular vascular services as well, but we have started to focus more energy on patient and provider education to help transition some of our non-surgical patients to other management and monitoring pathways. Each of our clinics has specific staffing and supply models that best allow us to treat each type of patient. This enables us to deliver appropriate care efficiently: cutting costs, reducing wasted clinic time and decreasing patient frustrations.
Is our practice model perfect after all of these years of tweaking? Of course not. But sitting down and gaining some clarity about which patients were coming to our office and determining what their primary concerns might be has made a huge difference in how I adjusted my vision of our business model. Over the years, our site has developed its niche within our group. Patients seem happier. We are able to deliver care more efficiently and with better outcomes. Our staff seems to be comfortable with our patient population’s concerns, which results in improved communication and triaging of issues. My local partners and I are much more satisfied with the care delivery we can supply as well as the resources we provide to our system.
Will this last? Probably not. No business model is static. So we continue to watch our patient patterns of need, and we try to bend with the wild winds of practice…
Every situation is different, of course. But there are a few elements that tend to rise up in most situations:
- Know your limits –> What can you do? What do you do?
- Be objective –> What do your patients actually need? Is this what you can provide?
- Have a plan –> Once you see where you are and where you need to be, how can you bridge that gap?
- Plan to change –> It’s a dynamic process! How will you continue to adapt?
In closing, I would like to offer a worksheet to help you gain a little clarity in this often-murky situation. It can be a difficult thing to realize that your practice isn’t the amazing treasure trove of sexy and exotic diseases that you thought it would be. Taking a good hard look at what you have to work with can make a tangible difference in your future success.