Practice management lessons from parasitology
It is time to find the parasites infecting your practice and either control or eliminate them.
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“The word ‘parasite’ comes from the Greek parasitos, which means ‘one who eats at the table of another.’”
–www.thoughtco.com
“Why haven’t parasites taken over the world? The answer is simple: they have. We just haven’t noticed.”
– Daniel Suarez
“Thought, like any parasite, cannot exist without a compliant host.”
– Bernard Beckett
My favorite teacher and mentor in high school was Boyd Smith, who taught biology. I was a complete lab nerd for all 4 years. Boyd indulged me, with what I later came to understand as a pretty great tradeoff for both of us. I had 24/7 run, summers included, of a well-stocked general science lab, complete with my own key. And he got my free labor to assemble experiments and class demonstrations, help grade papers and clean up after the lab’s abundant collection of critters (including a particularly unpleasant squirrel monkey, three saltwater aquariums, 15 snakes including a diamondback rattler and what we called the “rat ranch,” which is how all those snakes stayed fed).
Boyd’s favorite biologic subject — and thus, mine, too — was parasitology. When you are a teenage boy, parasites are pretty darned cool. What’s not to love about intestinal worms, fleas and ticks? How about the Guinea worm, a full meter long, that loves to burrow its way painfully from your groin to your foot? How hip is the Loa loa worm of West Africa, which loves to take up residence inside your eye?
I learned that if you are a parasite, your prime directive for a long and happy life is to not be overly irritating or deadly to your host.
And so it is with the parasites residing in your practice. Parasites, you may ask? In my practice? Yes, your practice probably has a number of vermin right now robbing it of vitality. These parasites, at least individually, are not especially deadly to your company; most of them you hardly notice.
But it can get worse. In your practice, as in nature, too high a “parasite load” can kill the host. Even “subclinical” practice pests can be debilitating if they add up or are present with larger shocks (like a pandemic, for instance). Let’s discuss a few of these practice parasites and their effective treatment and prevention.
Practice parasites
1. Underemployed staff. If you are reading this article in your office, get up from your desk and take a 2-minute walk through the halls. Is everyone gainfully employed this hour? If your clinic is still running a light coronavirus schedule, have you tapered hours or at least given underemployed staff projects to work on?
2. Excess or inefficient facilities. Every square foot you could do without costs at least $30 a year, which does not sound like much. But if you own or rent 500 more square feet than you really need, that is nearly a 5% annual pay cut in a solo practice. Anything more than you need is wasted. Find productive use for underused space, sublet to a compatible provider or negotiate with a neighbor to take over space you no longer need.
3. Provider time-wasting. In the last 40 years, I have shadowed thousands of eye surgeons. Most of them wasted at least 30 minutes a day on the clinic floor. Extra socializing. Screen time while patients are kept waiting. That represents about 2 weeks of lost time a year or, in economic terms, at least another 5% annual pay cut.
4. Inefficient protocols. Technicians, in an effort to cover all bases, sometimes ask history questions, apply measurements or provide patient services such as dilation that could just as easily be skipped on some selected visits. Anything that does not add to the value of the patient’s visit is a kind of “efficiency parasite.”
5. Underperforming vendors. Most of your service and product providers are timely, honest and well intended. But some are not. At least once a year, you should scroll through a list of vendors and replace any who are not providing at least as much value as you are paying.
6. Poor treasury habits. In 2020, practices without adequate capital access (money in the bank, credit lines, personal resources) have been hit hard. Every practice should have the equivalent of at least 6 months of basal operating expenses at the ready, in good times and bad.
7. Regulatory impediments. Unfortunately, these are endemic and almost impossible to treat. CMS controls 60% of your cash flow, and for all but a few nonparticipating eye doctors, this is weighing on your mind daily. Were it not for CMS (if we had something like the simplified Canadian approach to billing management), the average eye surgeon might save about $20,000 a year in practice staff expenses. Unfortunately, we do not have an antiregulatory DEET to keep third-party payer mosquitos at bay.
8. Underskilled administrators. Over the past generation, running even the smallest medical practice has become daunting. In the same period, administrator salaries have nearly doubled as practices have had to deploy better educated, more dedicated pros to handle today’s tougher environment. If your practice has outgrown your administrator, it is false economy to simply live with it. Either upskill your manager, buttress their weak areas with outside specialist help or trade up to the next level executive.
9. Disengaged managing partners. Administrators are only half of the practice leadership equation. The client practices that have flourished — at least in relative terms this year — are those with strong, engaged MD leaders. They have not only been leaning into the classic medical director’s role of assuring staff and patient safety, but also deeply comanaging financial and cash flow issues with lay staff.
10. Distracting personal issues. Owning and running a practice is nearly all-consuming this year. Doctors and managers alike must have their personal decks cleared off to handle 2020’s supplemental challenges. This has not been a good year to deal with family issues, personal health challenges or building a vacation home.
Control the parasites
In medical practice, the aim is to thoroughly eliminate a patient’s parasites. A good worming, and they are good as new. But sometimes all one can do is tamp down a parasitic infection or retreat recurrent infestations. Every vigilant parent keeps a bottle of RID on the medicine shelf for their child’s next bout of school-borne lice.
Analogous efforts apply to your practice. Some practice “parasites” are nearly irreducible; you will have to live with the complexities and frustrations of CMS the rest of your career. But most of the infestations that now weaken your practice can be either eliminated or at least controlled:
- Inefficiencies can be rooted out and reformed with protocols and training.
- Leadership can be developed through in-house training and outside coaching.
- Protocols can be streamlined to eliminate waste and duplication.
- Financial reserves can be built up and then sustained at pre-agreed levels.
Why is this so important in 2020, this pandemic year? If you think of your practice as a complex, living organism, COVID-19 has been what biologists would call just one more exoparasite reducing your company’s vitality and, ultimately, for weakened practices, survivability.
- For more information:
- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John 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, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams, Simple: The Inner Game of Ophthalmic Practice Success and a new book, UP: Taking Ophthalmic Administrators and Management Teams to the Next Level of Skill, Performance and Career Satisfaction. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.