This article is more than 5 years old. Information may no longer be current.
Long-term business, life planning a critical task
Asking the right personal questions will help you achieve long-term practice objectives.
Click Here to Manage Email Alerts
“Let our advance worrying become advance thinking and planning.” – Winston Churchill
“If you’re planning only to make money and nothing else, you’ll be broke.” – Haile Gebrselassie
“Adventure is just bad planning.” – Roald Amundsen
It seems that about the same percentage of eye surgeons make long-term personal plans for their lives as make long-term plans for their practices — which is to say slightly more than 0%.
Why is this? Why don’t surgeons plan more? Why do most practices float aimlessly, goalless from year to year?
Is it because you were on such a determinant, externally driven scholastic path for so many years that you were deconditioned from thinking about the future because it was preordained for you? Is it because the future of medical economics is a bit murky so you figure, “What’s the point in planning?” Or is it because the hyper-detailed, in-the-moment ophthalmic mind is unaccustomed to longer time frames? Perhaps your comfortable cycle time is the few minutes separating patient 1 from patient 2, not the few decades separating graduation day from your eventual retirement.
Whatever the reason, most ophthalmic practices and ophthalmic lives suffer from planning insufficiency, and the two are connected.
Inspiration for planning
What stimulates planning, anyway? Generally speaking, fear and greed. Let us cover fear first.
What induces fear? Change, or at least the prospect of change. The depth and tempo of business planning and plan revision are driven by how fast conditions are changing.
Although most surgeons perceive that their practice environment is fragile and changing very quickly, the business of medicine moves at a glacial pace compared to most industries. Medicare fee cuts, rising regulatory hurdles and related practice bogeymen are benign compared to the pace of change in most business spheres.
Imagine being the CEO of Blackberry with a smartphone market share of 37% in the U.S. just 3 years ago, and getting your clock cleaned by Apple, so that you now own less than 6% of the market and are bleeding cash. That kind of abrupt displacement does not happen very often in ophthalmology. As a result, most ophthalmologists do not have much of a fear-based incentive to plan ahead.
How about greed — or, more genteelly, “ambition” — as a driver for planning? Certainly, you are unlikely to become an eye surgeon unless you are academically ambitious. But unlike industrialists, who are commonly driven at the outset of their careers by a personal desire for great wealth, most ophthalmologists are not especially financially driven, although most eventually become very well off. Furthermore, most surgeons live well below their means. They possess a kind of “need insufficiency disorder,” which can make it hard for administrators to light a business planning fire under them.
What else inhibits the process of planning? A distaste for confrontation. Ophthalmologists are notoriously conflict averse, which works against planning, at least in a group context, because planning obliges confrontation in the good and utilitarian sense of the word.
Harry wants to grow the practice. Sue likes the practice just as it is. Mike is overwhelmed and would like to shrink back to the way things were. These differences are important to work out, but eye surgeons are generally conflict-avoidant. So, sitting down around the table and coming up with a plan for the long-term future does not come naturally.
All of this should not be taken as an excuse for not planning. Change is an accelerating factor. There is more to rationally fear in the future environment. But, happily for the most ambitious surgeons reading this, there is also more opportunity than ever before to build a practice that is both clinically vanguard and commercially robust. There are more high-income eye surgeons today than at any time in the past.
Pearls for planning
Here are five pearls to kickstart longer-term planning in your practice.
All business strategic planning starts with personal planning. I once had a confused client in his 50s, with a net worth vastly greater than his lifetime needs, who no longer enjoyed medicine. He said he hired me for advice on how to build an even larger practice. This assignment quickly pivoted to helping this surgeon retire and divest his practice to a local colleague. As the saying goes, “All business is personal.” That goes double for eye care, where you are personally on the front lines of customer service. Make sure you are clear about your longer-term personal goals, or your business planning will lead to creating an organization that is at odds with your life.
Know the environment. In most markets, your practice is no longer an island. What you will be able to build and add in the future (satellites, specialty services, ancillary care, etc.) will depend on increasingly fragile access to patients. In the next decade, some of you reading this will be locked out of access to newly developing managed-care patient populations.
Be realistic about your skills; add complementary resources. You are probably a terrific surgeon; it is less likely that you are a great accountant, lawyer or marketer. If your ambitions are high, draft proportionate resources.
Perfect the core of the profession. Your practice is not the Ford Motor Company. As you walk from one exam room to the next, you are personally creating and selling service-value units to one patient at a time. Five hundred great patient visits a month make for a great practice. Do not try to expand until you can get the basics right.
Strategic planning is a dynamic process. The first draft of your plan is just a start. Your plan should be a living document, updated often.
Answer several simple questions about the years ahead:
- What is our natural service area?
- What services will we add or subtract?
- What is our positioning? What will we be known as? The discount practice? The most costly offering in our market? The managed-care practice?
- What will be our provider mix? What should be the ophthalmologist-to-optometrist ratio?
- How fast will we aim to grow? Growing 4% to 5% per year will preserve our market share; growing faster will boost our market share but can lead to operational hiccups.
- What ancillary services can we add to counter stagnant professional fees and rising operating costs?
- What will be my succession plan? How will I exit and recoup my investment?
Conclusions
The formal process of nominating a strategic plan for your practice will force you to see that practice and personal ambitions are entwined. The deliberate act of strategic planning, after years of random development, usually brings up insights beyond, “Where am I taking my business?” For thoughtful surgeons who are ready, the context broadens to, “Where am I taking my life?”