Delegate, triage and compartmentalize problems to simplify your practice
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“If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.”
– Albert Einstein
“Problems worthy of attack prove their worth by fighting back.”
– Piet Hein
Except for the first and last few years of life, when the most fortunate of us are largely problem-free and tended to by loving parents or by equally loving and professional nursing staff, life is a parade of problems.
I cannot imagine a more problem-clogged moment than what is being experienced now by mid-career ophthalmologists. Count ’em up:
- The usual baseline of problems one has always had as a practice owner: hiring, training, doing battle with payers, containing costs, moving offices from time to time and responding to your partner who says, “It’s time I told you. I’ve just broken up with the technician I’ve been dating for the last 3 months. Her husband has convinced her to file a harassment lawsuit.” (True story, by the way.) Oh, and the 40 or 50 problems that patients present every clinic day — they count, too.
- COVID-19 and the exceptional no-good rotten year that was 2020 (which promises to linger as an only somewhat improved 2021).
- The unique problems and adjustments of the heated ophthalmology space: new procedures to learn, equipment to purchase, private equity pitches to sift through and local consolidations that may be leaving you concerned about the viability of staying in boutique-scaled private practice.
- Then there are the biggies of our time: Retirement planning adrift and at the mercy of an overpriced stock market and rising inflation. Global climate change and accelerating extinction. A toxic body politic and a downshifting role for America in the world. A return to the Cold War, but now with three contestants instead of two. Jobs (including lots of medical jobs) soon to be lost to technology.
- And all of this is embedded — if you are a mid-career surgeon in your 40s or 50s — in a stage of life that specialists in happiness tell us are the least happy and most problem-laden.
Even seemingly wonderful opportunities are just problems in larval form. Say you are approached by a local colleague who wants to sell you their practice. Great opportunity, right? Perhaps. Until you add to the purchase price the grab bag of problems you will inherit: lots of paperwork and legal fees, new staff to accustom to your ways, and the glaucoma patients who have been conditioned by their old doctor to be seen just once a year instead of on a more contemporary schedule. By the time you slay these problems, your “opportunity” may leave you with less income per hour than when you started.
It is kind of depressing and exhausting. And that is part of the problem. In our consulting work around the country, we are seeing more practitioners whose “problem density” (the number and scale of problems they are dealing with at any one time) is overfilling any reasonable human capacity. Of course, COVID has been the last straw of the Arabic proverb about broken camel backs.
Let’s provide a small measure of relief with some pearls about problem solving.
1. Not everything that you are calling a “problem” is your problem. In fact, most of the pressures of modern medical practice are not your problem at all — they are “issues” that have to be lived with rather than solved by you. One example is the anticipated rise of wage inflation. The typical general practice pays the average lay staffer a total of about $45,000 a year and spends about 30% of every dollar taken in on wages, taxes and benefits. Depending on your market (urban settings will be harder hit than rural ones), we can expect labor costs to be rising, while fees will be flat or falling. Beyond squeezing out the last ounces of labor productivity, you may have to live with slowly tapering profit margins. So it has been for the last 30 years. So it will go in th-e years ahead.
2. Any problem you can afford to have someone else solve for you is not a problem. Maybe this is why most people living in capitalist cultures hanker for wealth. With enough wealth, you can not only afford a swank vacation home, but a property manager to oversee it, a pilot to fly you to it, and a general manager to oversee the property manager and the pilot. Of course, doctors enjoy a degree of this even in the smallest practices. You have a patient who needs a test. You have a tech who can do the test for you. You have a chief tech who makes sure the job is done well and briskly. You have an administrator who oversees the head tech. In a well-managed practice, as the practice owner, you just have to stay close to the administrator, and you can get help with that from your attorney, CPA and consultants.
3. Learn to triage your practice problems, which can be graded for their severity and potential for adverse impact, just like a trauma case. Problems come in various degrees:
- Minor nuisance.
- Irritation.
- Run-of-the-mill practice problem (the most common kind).
- Crisis.
- Hot mess.
If your problem-solving resources (time, money or expertise) are limited, you may only be able to attack the priority items. Work with your fellow doctors and managers to develop the skills needed to sift the big problems from the little ones. One of the most common practice failings I see is the misapplication of an owner’s attention and energy, which can leave them starving opportunities while squandering resources on distracting, nickel-and-dime problems that can be saved for another day.
4. Complexity and success and scale beget problems. Henry David Thoreau learned living on Walden Pond that, “Our life is frittered away by detail. Simplify, simplify.” Not even 21st century monks live as simply as Thoreau once did. And modern ophthalmologists certainly don’t. Practices may grow linearly, but their complexities and problems grow logarithmically. Two offices are four times more complex and problematic as one office. So, consider wisely before undertaking any expansion:
- Adding offices or staff;
- Adding new service dimensions such as dry eye treatment; or
- Taking on the next partner-track associate.
5. Hire a stronger, better, faster, smarter, more experienced administrator than you think you need, no matter the size of your practice. As a cost-saving measure, too many doctors hire the least expensive, least experienced manager they think they can get by with. The result is that problems bounce right back to the owner’s lap and are actually amplified by an inexperienced manager’s inattention. It only costs twice as much to hire the best. Spend the money.
6. Delegate your problems to experts; you don’t have to go it alone. Rather than worrying if your new building’s architect knows what they are doing, pull in a detached expert to render a second opinion. Hire lawyers to fight your unpleasant battles for you. Hire marketers to slay the competition.
7. Learn how to compartmentalize your problems. You do this naturally in the clinic, shutting down your thinking about the problem of Mr. Smith in room two as you walk into room three and greet Ms. Jones. In business as in medicine, be disciplined and focus on one problem at a time.
8. Timing is everything. Most problems, clinical and otherwise, get larger over time, and it is best to not procrastinate. An obviously ineffective member of your staff is unlikely to improve in the next year. On the other hand, some problems get better or disappear altogether with the tincture of time. Think about this the next time you are about to jump on your manager for some minor transgression, one you know they will find and correct on their own in short order.
And finally, as I last wrote in 2005 in this space, realize that you can handle only so many concurrent business (or life) problems at a time. Consider the biological parallel of parasite loads. Your practice may be able to fight off five problems at once, while 50 problems are crippling to the organism. Try not to create situations for yourself where you have to solve lots of extra problems in all the areas of your life at the same time. As a dear client once said, “I try to avoid creating situations where more than one person is mad at me at any one time.”
- For more information:
- John B. Pinto is the author of several books on ophthalmic practice management, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at slackbooks.com. Receive 20% off with promo code PINTO20. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
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