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Select the right team of advisers
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As a physician, you have more advisers than the typical person has: colleagues down the hall, your administrator, scores of vendors who teach you how to use their products, the mechanics and technicians who keep it all working, plus various professionals of every stripe who help you make more money, save it, count it and keep as much of it as legally possible from the IRS, unworthy heirs and plaintiffs’ attorneys.
The anthropologists got it wrong: Man is not a maker of tools but a maker of opinions traded widely in this modern world.
That is the setup for this brief discussion: Do you have enough of the right advisers, are they integrated as a team supporting you, and do you use them the right way?
General business and specialist attorneys
They (and you should have one lead, go-to person, even if you employ a firm) should have gray hair and a super-organized assistant and also be slow to anger and skilled in their ability to extract justice from those in your world who will from time to time prey upon you, your business and your family. Like your general practitioner, they will know when to handle your matters personally and when to call in the specialists.
The most fortunate doctors have a few of these specialist attorneys on retainer. They come in every variety to unravel all of the modern tangles we manage to get into: tax issues, bankruptcy, divorce, partnerships, contracts, regulatory compliance, employment law and so on.
Accountants
If your financial matters are blessedly simple, you are joined at the hip with one widely skilled, affable-if-a-bit-dull numbers professional who can handle everything. But in today’s increasingly complex world, accountants are specializing to a similar degree as attorneys and doctors. There are forensic accountants to testify before a court, analysts to drill down into arcane business math problems, as well as the familiar kinds who help you close your books at the end of year. Career-long relationships are not unusual. If you are a young doctor, pick a young accountant who is backed up by a senior partner for the tough stuff.
Personal financial planners
These come in many flavors and skill levels, from the highly trained and skilled professionals who will provide unbiased counsel and help you stay on a conservative retirement track to wannabes with a $25 certificate, a nice suit and marching orders to churn your account. Use recommendations from your most financially successful friends to find a fee-only planner who feels “just right” from the first meeting onward. If the stakes are high or you are nearing retirement, do not be shy about getting a second or third opinion on the strategy you are taking.
Practice management consultants
I have an inherent conflict to say much about this because I am one, but here goes. I admire most of my colleagues. Just like the surgeons we work for, we learn something new from every assignment, we learn from each other in this “micro-guild,” and we get better at our jobs over time. I wince reading reports I wrote 25 years ago for clients, probably the way you wince at old postop patients dating to the second week you were learning phaco.
Practice management consultants are typically generalists. We have seen lots of case histories go by, and we get good at recognizing patterns. Just like you, we do our best work for doctors with real problems (or opportunities), doctors who are either nice people or at least only temporary pains-in-the-rear because of a tough patch they have hit, and doctors who remember to say thanks when the treatments we apply work especially well. Every practice should have one of these consultants, but that is just my advice.
Billing, coding and compliance advisers
All surgeons should also have one of these important experts in their practice. For the typical, well-run Medicare-based practice, a peek in the charts every 2 to 4 years is simply good housekeeping. For practices with chronic difficulty in this area, more frequent review is indicated.
Personal physicians
Most ophthalmologists I know have not had an eye exam in years. And unless they are in the midst of a health crisis or being treated for a chronic condition, they similarly skip the traditional annual exam.
Even if you are in the pink, your “personal board of directors” should include an internist or general practitioner who you think is even smarter than you. Keep searching until you find one.
Mental health professionals
I live in California, where they have just passed a new law that says everyone has to have a personal shrink. Or so it seems. Seriously, ophthalmology is an emotionally challenging business conducted by generally high-strung people. Most benefit from counseling of one kind or another (as we all do, probably).
Rather than an infrequent touch-and-go landing in a crisis, which is all the average person can afford, consider using your psychologist, psychiatrist, pastor or counselor as someone you see every few months, even when life is completely wonderful. Think of it as flossing for your brain. And when the next personal crisis arises, you will already have a strong, trusting relationship with someone who can immediately grasp your new issues rather than taking a few warm-up sessions to develop rapport.
Personal trainers
I think this is another California invention. In Vermont, your average guy goes out, chops some wood, shovels some snow and the daily workout is done. In California, “cords” of wood are really little and made of fiberglass for our artificial fireplaces, and snow is something we import from Canada to SeaWorld around Christmastime so the kids can fall down and make angels for a day.
Out here, we need someone to tell us how to work up a sweat, and maybe you do, too. Like most professionals, half the value of an athletic trainer is to provide a source of external discipline — at 5 a.m.
Occupational/physical therapists
If you are developing neck or back pain, and especially if you have progressed to the too-common stage of tingling fingers and other signs of the frank harm your posture is doing to your career longevity, consider a consultation with an occupational therapist or physical therapist. Have one come to your office and surgical facility to observe. Together, you will be able to collaborate on creative solutions such as ocular extension tubes on your operating microscope or sandbags to prop your wrists at the slit lamp, taking the pressure off your lower back and neck. If you are a woman, they will tell you to stop seeing patients while sitting “side-saddle” out of modesty and to simply get in there and straddle the patients like the guys do.
Most of these experts should not operate independently but rather be arrayed by you into teams for best effect. For example, you and your accountant, attorney and practice management adviser should confer jointly on big issues. It is vital that your accountant, administrator and personal financial planner be in the same room with you at least once a year to orchestrate a plan on your behalf. Depending on your health status, your various fitness and health advisers should each know what the other is recommending.
John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. He can be reached at 619-223-2233 or pintoinc@aol.com.