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The fine art of quitting: how to make a strategic retreat
Withdrawing to fight another day can be an honorable, effective long-term strategy for success.
I’ve just learned that General George Washington’s army lost more battles than they won, yet they prevailed in the Revolutionary War. In a recent syndicated column, George Will wrote that America won the war not so much because of decisive victories, but because of its superior retreats, such as the one after the British landed on Long Island with an army larger than the local population of New York City.
Perhaps it’s useful to think of your practice career panoramically in the same terms. By the time it’s over, you will have had some 30 years of victories and defeats, advances and retreats. For those of you reading this who are older, you already know your career has been shaped as much by the strategic retreats you’ve made as by the advances. Whether in battle or in business, there’s no dishonor in withdrawing to fight another day.
Example
Take the example of a West Coast client, who some years ago left his large group practice to hang out his own shingle. Trouble is, he had no preparation — and no real interest — in the details of running a practice, something that had always been done for him in his large group. Compounding this was the open checkbook he gave his first office manager to find and equip an office. “Mary” rang up bank and equipment leasing liabilities — most of it with personal, not corporate, recourse — exceeding $1 million before the practice was 6 months old. It was a mountain of debt, and this surgeon spent the next 3 years trying to keep up with it. But they don’t give out prizes for going broke slowly. In the end, the only reasonable course was for this gentleman to declare bankruptcy and accept a partner-track position with another large group. After a strategic retreat from an untenable position, he’s happy and prosperous today.
Strategic retreats
There are many such strategic retreats in modern practice. One of the most common today is the retreat that lower-volume refractive surgeons are making from vision correction surgery. Hundreds of ophthalmologists who thought it would be both professionally interesting and highly profitable to add a modest LASIK service to their largely geriatric businesses are realizing that it’s easier in most circumstances to grow by adding services of interest to your existing customer base than by finding an entirely new pool of customers.
The same can be said about the shopping basket of cosmetic and aesthetic services like dermabrasion, facial peels and even elective cosmetic (as opposed to functional) blepharoplasty. These are services that seem intuitively sensible to add, right? But they end up being empirically wrong in almost every setting. With few exceptions, the profitability of these services is terrible compared to mainstream ophthalmic care. As a result, most minor cosmetic procedures offered in ophthalmic practices are break-even at best, and at worst are an expensive gift to your staff and your spouse’s social circle.
Remember that the acid test for adding a new product or service to your practice is: “Will this either measurably improve the quality of care we offer our patients, or will this increase our profit per surgeon-hour?” Exchanging $100 net-per-hour cosmetic services for $400+ net-per-hour classic ophthalmic care may be temporarily interesting if you’re getting bored with geriatric ophthalmology, but it’s a prescription for financial decline. In your own setting it may be better to beat a retreat today to the most profitable segments of eye care, and leave behind a battle with dermatologists and boarded plastic surgeons that you can certainly wage but are unlikely to win.
Other battles
What other battles should you quit? Let’s turn to low-profit and no-profit managed care contracts. These are signed innocently enough when you sense your clinic is not busy enough. (Have you ever noticed that contract signing time often coincides with those times of the year when practices are less busy?) After all, better to fill those empty appointment slots and enjoy a little marginal revenue, right? Wrong! Unless you’re desperate for a near-term capital infusion, accepting ultra-low-fee and low-capitation contracts will only lull you into a sense of practice satiety, just like eating wood chips might give you a sense that you’re well-fed. Instead, such contracts devour the time needed to improve service quality and to plan and execute the marketing and outreach necessary to attract, over time, a higher-yielding patient base.
You should also retreat from the people who are wrong for your practice. Think to yourself: “Do we have any lay staff or associate doctors who should be terminated today? If so, how long ago should they have left the practice? Why have we kept them so long?” The same question set applies to your fellow practice partners. Should you keep up appearances — or worse yet, the heat of battle — or retreat from a partnership that isn’t working? If you’re an employee in an unwholesome setting, should you be quitting the battlefield your practice has become?
Continuing the evacuation list, have you been putting off abandoning equipment that no longer works properly or should be replaced by a more profitable or clinically appropriate alternative? Are you maintaining unprofitable satellite offices — maybe branch offices that worked a decade ago when you were more energetic or worked for higher fees, but are now personally exhausting or diseconomic? Should you retreat from surgical or clinical procedures you don’t do all that well personally or have not kept up with? Are there business procedures your staff now do more by rote, from outdated standing orders, than for any practice benefit? Are you still gathering financial or volume performance data that you’re no longer using to make management decisions? Ponder each of these questions, not in the abstract, but as they apply to your specific setting.
Inclined to win
Are you doing things for yourselves within the practice, like payroll administration or office cleaning, that a vendor really could do better and cheaper? On the flip side, has your practice become larded with an overabundance of vendors, who are performing functions better left to internal staff? Go through your general ledger, vendor by vendor, and give each a score for necessity and performance.
Finally, and most broadly, is it time to drastically change your professional context? Is it time to be leaving the academic world for private practice, or vice versa? Is it time to stop your surgical career or leave medicine altogether?
Is it OK to quit? In some cases, no matter how foreign “giving up” is to the average eye surgeon, the answer is “absolutely.” By confronting these difficult questions — and achieving a better life and practice with a little well-timed subtraction and backtracking — you’ll be more inclined to win, like General Washington, over the long run.