Ophthalmic partnership happiness dependent on key success factors

Most group practices place a higher priority on existential values, rather than financial and volumetric gains.

Issue: July 10, 2008

ByJohn B. Pinto

John B. Pinto

It has long been observed by those jealous of the profession’s often abundant material success that there are just two kinds of eye doctors: ophthalmologists who are trying hard to be businessmen, and businessmen who are trying hard to be ophthalmologists.

The strongest and most successful multi-doctor practices have both kinds of ophthalmologists and need them more than ever, working together harmoniously in an increasingly challenging and business-oriented environment, where real benefits are beginning to accrue to those able to manage large-scaled enterprises.

And therein lies a paradox. The patient and payer world, along with rampant technology, demands greater specialty practice scale, which allows deeper specialization, one-stop shopping and contracting, and the ability to amortize fixed costs among many partners. However, team harmony and individual provider happiness tend to fade as groups supersize.

No matter how unified, business-like and successful a group practice may appear from the outside, there can be a core of profound inter-partner discord, oil-and-water personalities that simply do not mix or mistrust borne of perceived old slights.

Here is a list of determinants to partnership happiness that I sometimes distribute either as a survey or simply as an aid to discussion in group practice client settings — whether there are two doctors or 20 — to help everyone get in touch with their priorities. Interestingly, financial and volumetric gains are rarely at the top of a doctor’s wish list. Most partners seem to place existential values — “how does it feel to work here?” — ahead of raw commercial success.

Read on and examine your feelings about this list. What is your rank order of the impact of these determinants on you and your group’s happiness? (The order shown below is typically how your peers rank these issues from most to least important.) Then, how would you rate how you are doing in each area today in your own practice on a 1-to-10 scale? What special additional practice satisfaction factors not listed here are also important to you? Finally, what could you and your colleagues do to raise your scores in each area?

“I am confident that we do a great job for our patients.”

This lies at the core of every competent professional’s sense of well-being. Although a few immature providers go through their early post-graduate years thinking that the most important benchmarks are financial, at some point — earlier rather than later for the best doctors — the metric becomes delighted patients with outstanding medical and surgical results and a trusted doctor-patient bond.

“We enjoy the admiration of our peers.”

You work hard, largely for your own satisfaction, of course. But if you can delight your patients, you are reassured that you are a competent professional. When you also win praise from your peers, even local competitors, your sense of accomplishment is profoundly leveraged. This is high on the list of determinants of professional satisfaction. In groups where the partners do not admire each other, it is hard to build much teamwork.

“We have created one big, happy family here with much interpersonal trust, warmth and high regard between doctors, managers and staff.”

If you are the typical ophthalmologist, it is likely that you spend more quality time with your lead tech than with your own children. The most conscientious eye surgeons work as hard on their interpersonal relationships in the office as they do at home, listening carefully for any signals that they have given offense and never overlooking an opportunity to grow closer to their team.

“We have a great deal of clarity about the future path of our practice and are confident we can attain our goals.”

Even more important than a written business plan in the typical practice is a history of small group achievements and successfully overcoming past difficulties. These give the entire team confidence and a sense of momentum in facing the future.

“We trust our leaders.”

Larger practices run poorly and make for unhappy career settings without strong, trusted managing partners, administrators and department heads. This does not mean “flawless” leaders, but leaders who are realistic, wicked-smart, sensitive to the group’s will, non-defensive and open. Abundant capital, dominant market share and the best business plan in the world will not overcome a gap in leadership.

“We relish the day-to-day enjoyment of our work, with fun, laughter and even a degree of bliss, especially in our contact with patients.”

Face it. After a few thousand patient encounters and the first few years of practice, you are going to be seeing the same presenting conditions over and over again. If you are purely a surgical technician, you will grind through a day of clinic to harvest a few interesting cases to operate. But the happiest surgeons I know are those who do that and genuinely enjoy the face time with every (or nearly every) patient.

“We successfully exercise good control over operational processes in the practice.”

Control equals happiness just as much in practice management as in surgery. Group practices complete hundreds of key processes daily, most of which are critical to seeing patients on time and getting paid for the work that is done. When enough of these steps are botched, even the most talented surgeon cannot recover a patient’s confidence – or his own.

“I feel I have a real influence on the board and in practice governance matters.”

Whether you conduct business as “one doctor, one vote” in your practice or submit to the controlling fiat of one majority partner, every owner is happiest knowing that he has a fair voice in business affairs that is roughly proportional to his revenue contributions and seniority. It is for this reason that senior/founding doctors will commonly surrender their 51% share in the interest of greater harmony, trust and the ability to attract talented providers. (Note: The founder’s reasonable rights as a minority owner — such as not getting voted out of their own practice — can be generally well-protected in the shareholder-partnership agreements.)

“My compensation is fair for the work I perform compared with other doctors inside and outside the practice.”

It is easy to remember the heady days of 50+% practice profit margins and harbor unrealistic expectations about the income potential of modern eye care. In group practices, a sense of financial equity can be fostered with frequent benchmarking to similar sister practices and having a standing subset of the board — the “compensation committee” — produce an annual fairness opinion document. It is far better to make small, regular adjustments rather than infrequent jarring changes to the compensation model.

“I possess an intimate understanding of our company and how the business side of the practice works.”

It can be intellectually frustrating to be a consummate expert in one domain — eye surgery — and to feel hopelessly ignorant about how the business side of your practice is conducted. Given the simultaneously growing challenges in both medicine and management, it can feel rather hopeless to stay competently abreast of both areas equally. However, this is essential.

“We enjoy a high degree of control over our market position and access to patients, cases and contracts.”

The best patient care in the world needs patients to fulfill its mission. If you have too few new patients or the wrong mix of patients, this lack of control will eventually tear at group harmony and create an environment of internal competition. The best, happiest practices spend adequate resources on internal and external marketing, proportional to subspecialty demands, local competition and partner ambition.

“Individuals here have access to any reasonably desired technology and new techniques; we are not being held back by partners.”

It is very frustrating, especially if you are in the robust, hard-charging middle years of your career, to feel held back by your colleagues, either because they are overly cautious fiscally or they take a circumspect approach to patient care. This plays out with especially hard feelings in refractive surgery, oculoplastics and retina, in which large, front-end outlays are commonly needed to stay current.

By bringing this list of partnership happiness factors to an upcoming board meeting, with or without an outside facilitator, you will get to the heart of issues that may have prevented either you alone or others in your group from enjoying the fullest possible professional life.

For more information:

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees and The Women of Ophthalmology. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.