By Hilliard Slavick, M.D.
When I began my practice 30 years ago, many community hospitals operated like “gentleman’s clubs” in which one doctor or one group controlled all neurology services, including consults, EEG readings, and EMG performance.
Due to the lack of competition, one only needed the loyalty and support of the hospital administration and several key primary care physicians.
By the mid-1980s, that began to change. HMOs developed and contracted with neurology groups, who had exclusive rights to serve their outpatient clinics and inpatient admissions. I signed a contract at Michael Reese HMO after it became clear that a significant portion of my private patients would be quickly lost. After initially handling only EMG performance, we have expanded and currently service four outpatient clinics.
But the business side of neurology has not gotten any easier during the past 20 years ago.
We must take into account contract negotiations with fellow physicians, staff hospitals, and insurance companies. We incur expenses from support personnel such as attorneys, CPAs and other consultants. And new hires expect a great deal in terms of salary and benefits, before they have extensively demonstrated their skill or ability to generate revenue for the practice.
Increased medical malpractice rates due to our lawsuit-happy culture have cut into our profit margins, as have decreased payments each month from insurers. A planned 10 percent Medicare cut, set to take effect on Jan. 1, 2008, threatens to further cut our profits.
Further squeezing the cost crunch, most private insurers base their payments off the Medicare figures. And insurers’ bias toward paying for surgeries, as opposed to the hands-on cognitive assessment care we provide, does not help matters.
In the face of these converging factors, Clinical Neurosciences continues to thrive. I like to think we work harder than most people. I put in the hours, I lecture, I ran a board review course for five years. I’ve trained a lot of doctors over the years. I’m constantly teaching.
That’s the way to do it. You’re available to people. You just have to work hard and develop the mindset that taking calls at times that might be inconvenient is part of the process. When your primary focus is taking care of your patients, then those calls are not an intrusion, but a reaffirmation of your personalized approach.
We also see patients more quickly than university hospitals, which often have waitlists of three and four years, and I don’t have a different resident seeing them on each visit, which can be frustrating to people. We essentially have a family practice in neurology. If a patient is not improving after two, three or four visits, I refer them to people I think can handle their case.
Over the years, I’ve cultivated a number of specialists to whom I feel confident sending patients. They, in turn, refer patients to me.
At the end of the day, amid all the big-picture changes I’ve described, overcoming the cost crunch in neurology is not merely about making a series of good business decisions. It’s about embracing what you do, accepting the role you play, and managing that decision not only in your practice but also in the greater community that you serve.
Monday, August 27, 2007
The Joys of Private Medical Practice
By Hilliard Slavick, M.D.
Psst, want to know a secret? Running a private medical practice can bring terrific financial and personal rewards.
There, I said it, knowing full well that many in the medical community may now suspect I need to have my head examined.
The travails of operating a private practice are known all too well, and I will touch on some of them momentarily. But there are very real benefits, too.
At my practice, Clinical Neurosciences, we foster an environment of personalized care and independently provided advice. Being in charge means being a maverick, able to choose where you want to work and what you want to do without a department chairman’s approval.
So, opportunities abound to take on fascinating cases. Granted, you also take on some added inconvenience to your lifestyle: it takes a committed person to devote himself to the care of others beyond the world of 9-to-5. But a private practice retains its humanity, passion and relationship with clients.
The real joy of a private practice is seeing patients every day, meeting people and getting to know their conditions and personalities. As the tension between patients and insurance companies increases, it is important for individuals to know that their practitioner is giving independent advice regardless of external pressures.
They will learn to trust your opinion even more if the bond is stronger than a typical doctor-patient relationship. This connection with my patients has kept me motivated to strive for improvement, and is the reason I have stayed in private practice for 30 years.
The journey has had its challenges. For example, though I prefer to have three or four fellow neurologists on staff with me, for the past eight years I’ve only had two. And this summer, that number fell to one.
It’s becoming increasingly tough for private practices to attract, and retain, quality physicians.
Undoubtedly, the economic development of the HMOs in the 1980s has played a major role in this evolution.
The emergence of HMOs prompted private practices like my own to sign contracts with them or face a significant loss in client numbers. While the HMOs help to provide a steady influx of patient referrals, it has also been coupled with decreasing insurance reimbursements, higher risk insurance costs and tension with patients over coverage and treatment discrepancies.
Another significant factor that I’ve detected is an increasingly short-term mentality among young doctors who are more likely to join large group practices or university hospitals, focusing on subspecialties, rather than devoting time to a private practice.
Jumping to a larger practice group or a university might initially increase a young doctor’s salary or seem like a more stable option. But the downside to universities is their focus on teaching and research, dedicated more to scholarly work than treatment of patients.
I have seen the benefits to those in private practice who display dedication to their profession, as well as to forming relationships with patients, colleagues and staff.
Devoted mentors can make sizeable contributions to a young physician’s development and in a private practice one physician’s improvement sparks more satisfied patients and increased client referrals.
My first job after medical school was in a private practice where senior doctors took the time to mentor me. I improved not only my technical skills, but also learned the business tools from those doctors who had already navigated that road.
Though some may argue the way has become overrun with potholes and cracks, there is still a road map for one heck of a joy ride.
Psst, want to know a secret? Running a private medical practice can bring terrific financial and personal rewards.
There, I said it, knowing full well that many in the medical community may now suspect I need to have my head examined.
The travails of operating a private practice are known all too well, and I will touch on some of them momentarily. But there are very real benefits, too.
At my practice, Clinical Neurosciences, we foster an environment of personalized care and independently provided advice. Being in charge means being a maverick, able to choose where you want to work and what you want to do without a department chairman’s approval.
So, opportunities abound to take on fascinating cases. Granted, you also take on some added inconvenience to your lifestyle: it takes a committed person to devote himself to the care of others beyond the world of 9-to-5. But a private practice retains its humanity, passion and relationship with clients.
The real joy of a private practice is seeing patients every day, meeting people and getting to know their conditions and personalities. As the tension between patients and insurance companies increases, it is important for individuals to know that their practitioner is giving independent advice regardless of external pressures.
They will learn to trust your opinion even more if the bond is stronger than a typical doctor-patient relationship. This connection with my patients has kept me motivated to strive for improvement, and is the reason I have stayed in private practice for 30 years.
The journey has had its challenges. For example, though I prefer to have three or four fellow neurologists on staff with me, for the past eight years I’ve only had two. And this summer, that number fell to one.
It’s becoming increasingly tough for private practices to attract, and retain, quality physicians.
Undoubtedly, the economic development of the HMOs in the 1980s has played a major role in this evolution.
The emergence of HMOs prompted private practices like my own to sign contracts with them or face a significant loss in client numbers. While the HMOs help to provide a steady influx of patient referrals, it has also been coupled with decreasing insurance reimbursements, higher risk insurance costs and tension with patients over coverage and treatment discrepancies.
Another significant factor that I’ve detected is an increasingly short-term mentality among young doctors who are more likely to join large group practices or university hospitals, focusing on subspecialties, rather than devoting time to a private practice.
Jumping to a larger practice group or a university might initially increase a young doctor’s salary or seem like a more stable option. But the downside to universities is their focus on teaching and research, dedicated more to scholarly work than treatment of patients.
I have seen the benefits to those in private practice who display dedication to their profession, as well as to forming relationships with patients, colleagues and staff.
Devoted mentors can make sizeable contributions to a young physician’s development and in a private practice one physician’s improvement sparks more satisfied patients and increased client referrals.
My first job after medical school was in a private practice where senior doctors took the time to mentor me. I improved not only my technical skills, but also learned the business tools from those doctors who had already navigated that road.
Though some may argue the way has become overrun with potholes and cracks, there is still a road map for one heck of a joy ride.
Business Success Prescription: Plenty of Vitamin A (Affability)
By Hilliard Slavick, M.D.
When I entered Loyola University Chicago Stritch School of Medicine in 1970, it was not because I had a passion for business. Like most any other bright-eyed young med student, I craved the challenges and rewards of a career as a doctor.
Today, I am grateful that I am still able to pursue that dream of helping people get better. But along the way, I have learned that in order to keep on that path, on the terms that I desired, I needed to form habits and develop skills that are relevant for just about any business endeavor.
Of the many qualities that it takes to become successful, there are three A’s that stand out: able, available and affable.
Those words, by the way, are not listed in the order of their importance—not in my experience and, as I’ve observed over the years, not in the experience of a broad range of business leaders.
Show me a brilliant, supremely able neurologist who is arrogant and intimidating, and I’ll show you a business failure waiting to happen. On the other hand, if a neurologist couples competence with strong doses of genuine openness and likeability, then he or she can enjoy a thriving practice.
After medical school and residency, I have enjoyed a 30-year run in private practice, including the last 13 years as the sole head of Clinical Neurosciences in Chicago. In a medical realm where private practices have sputtered or fallen entirely by the wayside, to what do I attribute my longevity?
In my sporadic moments of excessive self-esteem, I like to think that it’s based on my resounding success in all three “A” categories. But if I have any kind of special smarts, it’s truly that I have enough wisdom to know that success isn’t about being the brightest guy or gal in the room.
Affability trumps all other traits.
Referring physicians must like a specialist in order to be comfortable in dealing with them as a consultant. They will then allow their patients to work with you. If those patients, in turn, also like the specialist, then it results in their positive feedback about the care provided.
The same beneficial cycle holds true for others, whether they sell shoes, supervise an assembly line or own a restaurant. People like doing business with people they like.
It’s all about having a team-first attitude. Praise your associates and others in your field, share credit and do all you can to make others look good. That spirit attracts people.
At the heart of affability is building relationships.
In my case, this has included mentoring others, such as students, RNs, physician assistants, interns and residents. It has also entailed communicating persuasively with a variety of people: my office staff, CPAs and attorneys, as well as hospital administrators and the doctors who refer patients and work with me in evaluating patients.
Think about what you do for a living, and all the people who help you make it happen—who can take steps, small or big, to help or to hurt you. Often, their behavior isn’t even on a conscious level—they simply respond to that still, small voice inside them.
So you need to decide which phrase you want those voices to whisper:
“She’s terrific to work with. Go the extra mile for her!” or “Here comes Mr. Know-It-All. He’s so smart, let him figure it out on his own.”
You should have learned this by now, but it’s worth restating: Be courteous to everyone, no matter the person’s role or status. Each relationship is different, though some of the most vital characteristics you should strive to embody are constant. Among them are judgment, empathy, honesty, and confidence.
By confidence, what I mean in the medical context is that you need enough personal confidence to make yourself vulnerable to other people, by providing care and diagnoses that the patient or the primary care doctor may question occasionally.
For those in other fields, how much and what type of input do you genuinely welcome? When results arise that counter your opinion, how do you respond? It’s at this crucial stage that you can blossom or bomb in a relationship, where you earn trust or stir animosity.
Don’t get me wrong—it’s obvious that technical skills are important, no matter what you do. But honesty, integrity, trustworthiness, personal strength, commitment, desire, and the ability to communicate with all parties involved in your mission are much more significant in developing a successful business.
This isn’t brain surgery, really. It’s more like a heart check-up: what’s your motive for doing what you do? When it’s in the right place, and has room to share with others, then you will automatically be a success not only in business, but also in this business we call life.
When I entered Loyola University Chicago Stritch School of Medicine in 1970, it was not because I had a passion for business. Like most any other bright-eyed young med student, I craved the challenges and rewards of a career as a doctor.
Today, I am grateful that I am still able to pursue that dream of helping people get better. But along the way, I have learned that in order to keep on that path, on the terms that I desired, I needed to form habits and develop skills that are relevant for just about any business endeavor.
Of the many qualities that it takes to become successful, there are three A’s that stand out: able, available and affable.
Those words, by the way, are not listed in the order of their importance—not in my experience and, as I’ve observed over the years, not in the experience of a broad range of business leaders.
Show me a brilliant, supremely able neurologist who is arrogant and intimidating, and I’ll show you a business failure waiting to happen. On the other hand, if a neurologist couples competence with strong doses of genuine openness and likeability, then he or she can enjoy a thriving practice.
After medical school and residency, I have enjoyed a 30-year run in private practice, including the last 13 years as the sole head of Clinical Neurosciences in Chicago. In a medical realm where private practices have sputtered or fallen entirely by the wayside, to what do I attribute my longevity?
In my sporadic moments of excessive self-esteem, I like to think that it’s based on my resounding success in all three “A” categories. But if I have any kind of special smarts, it’s truly that I have enough wisdom to know that success isn’t about being the brightest guy or gal in the room.
Affability trumps all other traits.
Referring physicians must like a specialist in order to be comfortable in dealing with them as a consultant. They will then allow their patients to work with you. If those patients, in turn, also like the specialist, then it results in their positive feedback about the care provided.
The same beneficial cycle holds true for others, whether they sell shoes, supervise an assembly line or own a restaurant. People like doing business with people they like.
It’s all about having a team-first attitude. Praise your associates and others in your field, share credit and do all you can to make others look good. That spirit attracts people.
At the heart of affability is building relationships.
In my case, this has included mentoring others, such as students, RNs, physician assistants, interns and residents. It has also entailed communicating persuasively with a variety of people: my office staff, CPAs and attorneys, as well as hospital administrators and the doctors who refer patients and work with me in evaluating patients.
Think about what you do for a living, and all the people who help you make it happen—who can take steps, small or big, to help or to hurt you. Often, their behavior isn’t even on a conscious level—they simply respond to that still, small voice inside them.
So you need to decide which phrase you want those voices to whisper:
“She’s terrific to work with. Go the extra mile for her!” or “Here comes Mr. Know-It-All. He’s so smart, let him figure it out on his own.”
You should have learned this by now, but it’s worth restating: Be courteous to everyone, no matter the person’s role or status. Each relationship is different, though some of the most vital characteristics you should strive to embody are constant. Among them are judgment, empathy, honesty, and confidence.
By confidence, what I mean in the medical context is that you need enough personal confidence to make yourself vulnerable to other people, by providing care and diagnoses that the patient or the primary care doctor may question occasionally.
For those in other fields, how much and what type of input do you genuinely welcome? When results arise that counter your opinion, how do you respond? It’s at this crucial stage that you can blossom or bomb in a relationship, where you earn trust or stir animosity.
Don’t get me wrong—it’s obvious that technical skills are important, no matter what you do. But honesty, integrity, trustworthiness, personal strength, commitment, desire, and the ability to communicate with all parties involved in your mission are much more significant in developing a successful business.
This isn’t brain surgery, really. It’s more like a heart check-up: what’s your motive for doing what you do? When it’s in the right place, and has room to share with others, then you will automatically be a success not only in business, but also in this business we call life.
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