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Team of advisers key to growing professionally and personally
Quality of life and a practice’s success can improve with the right professionals but can be ruined with just one wrong choice.
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As a surgeon, you render advice hundreds of times a week and hundreds of thousands of times in a career span. You advise patients in your exam room, staff in the lounge, fellow doctors at medical conferences and your golf buddy Bob on the 15th hole.
 John B. Pinto |
Of course, it is a two-way street. You are also on the receiving end of advice, or should be. As a physician, you have more advisers than the typical person: 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 set-up for a brief discussion this month, courtesy of OSN Practice Management Editor Emeritus Herve M. Byron, MD, who suggested the topic and urges you to ask: “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 attorneys
They (and you should have one lead, go-to person, even if you employ a firm) should have gray hair, a super-organized assistant, 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 …
Specialist attorneys
The most fortunate doctors have a few of these 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 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, 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 take a few warm-up sessions to develop rapport.
Personal trainers and coaches
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.
Nutritionists
If you have a weight control problem that has not succumbed to exercise and self-care alone, or even your new personal trainer, consider a nutritionist. Although you are a physician with lots of education and common sense, you will be introduced to new topics and tactics, one of which may just be the silver bullet you have needed to add weight, lose weight or just be more energetic.
Massage therapists
The practice of ophthalmology — and particularly ophthalmic surgery — is fraught with opportunities for repetitive motion injury, back and neck strain, and a host of musculoskeletal aches. In addition, being economically productive in modern practice obliges a far more hectic and stressful work day than a generation ago. A wonderful prescription for these low-grade, chronic assaults on your physique and your psyche is regular massage. Some surgeons I know reward themselves with this immediately after every surgical session to work out the kinks and decompress.
Occupational/physical therapists
Sometimes massage alone is not enough or is not addressing the underlying cause of your physical strain at work. 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 or the other 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.
Instructors in general
As a busy professional, you do not have the time to learn the guitar on your own, dabble awkwardly with oil painting, grind through a $299 language CD or figure out how to drive your new sports car with vigor. Being self-taught is a virtue for those who are time-rich and dollars-poor. If you are reading this, chances are high that you are neither of these. A professional teacher of any kind who can come to your home or office, assess your skills and efficiently push you to the next level will save you precious time and frustration.
Architects
The most talented architects I have met are among the most interesting and intellectually balanced people I know. Consider the skill set: math, engineering, complex building codes, changing materials science, aesthetics and economics, along with a rather large dose of psychology to deal with clients. It is too bad that you only need them a few times in your life.
Handymen
As I write this month’s column, “our” Bruce is downstairs hammering away at the pipes. Bruce is pretty much a regular around our house. Even if you live in a new house and work in a new office building, you still need a guy such as Bruce to keep up appearances, get after the stray stucco cracks or at least pound on the pipes, smile a lot and look busy.
And finally, we come to …
Landscapers
When I was 13 years old, I started mowing yards in our neighborhood for a quarter a week. And I even paid for the gas (or at least my dad did). Not anymore. Today, unless you are satisfied with “mow-blow-and-go,” you need to hire a swank outfit. The quality of your life and the success of your business can be measurably improved with the right professional team and ruined with just one wrong choice.
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.
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.