Berning & Affiliates

Personal Attention and Feelings

Congratulations, you are the CEO of a growing and dynamic practice. One of the benefits of the larger practice is having personnel to assist you accomplish tasks or implement practice objectives. In a word, you have the luxury to delegate. Warning! Anything that makes staff or patients feel faceless, not personally cared for has the seeds for rude lessons both organizational and marketing. In health care, it is my experience, that the doctor CEO must not only accelerate effective systems and marketing but also must seek to maintain a personal relationship with staff, knowing who they are as individuals and as members of the team. By doing so, turnover is minimized and loyalty is improved. With patients, no matter how big or important the practice, personal attention, quality interaction of the doctor and patient must be preeminent or dentistry and your practice will suffer in a manner similar to the larger group physician practices.

Taking Time for Fun

We all have different definitions and enjoyments that we call fun. In my case, I have enjoyed a wide variety of activities, in part by joining in with many of my clients in what they enjoy! In a recent memorable and just plain fun outing, I joined with Dr. Robert Fisher a pediatric dentist from Northern California to hike in the Yosemite high country at Tuolumne Meadows (http://www.yosemitefun.com/tuolumne_meadows.htm). We hiked from about 8,500 to 10,000 feet and enjoyed a great camp out with lots of superb views, scents and discussion. Here's hoping you get your share of enjoyable times by scheduling it right into your annual planning as a CEO leader.

Is Your Partner Giving You Heartburn?

It happens. There is no question that periodically, and sometimes chronically, a partner rubs you wrong. Sometimes it is because issues that should have been discussed at the start of the relationship never were and now keep coming up. Other times it is for the most diverse set of temporary or passing reasons. For whatever reason if you, in the words of one of my clients, feel like "leaving the party", but the practice and your interests and income are satisfactory - resist! It is far easier to work to resolve matters or issues than leave and work to start over or to push someone else out. Using trained facilitators or mediators is a proven way to get issues out and work to resolution. Don't keep dealing with heartburn when you can reduce your stress and move beyond the problem(s) with a focused mediation.

"To A Degree"

In a recent discussion with a specialist who had just opened a new practice location, I asked if he had studied pertinent demographic information prior to choosing the location. His answer was, "To a degree". I found this a surprising answer given the nearly $500,000 spent to open the practice in leased space. He said that he had been in the area for 5 years prior to opening the practice and so he knew about the location. Of course now a great deal was dependent on attracting patients and making the practice viable. We talked about his marketing challenges and lack of patients and, given his limited study of demographics, his answers were lacking in detailed prospective resident and business information. In my view, it is critical to secure detailed area specific demographics when considering any practice related initiative. Just a cursory look or thinking that as a doctor CEO in a local area for a number of years means that you know everything about the area can be costly and just plain wrong. Whether for a new practice or established practices, ordering a demographics study for your practice patient drawing area is a prudent step prior to any transition, marketing or expansion initiative. See how at:  http://www.berningaffiliates.com/demographics.htm

Confidential Treatment of Doctor CEO Information

An orthodontist client recently inquired about advisors in general and my position regarding whether the doctor could anticipate that the discussion with a consultant is confidential. Here is a portion of my reply with some modifications for the use on this blog. "I appreciate receiving your inquiry. This is an important question particularly given doctor's practices becoming ever more prominent in their market areas and so potentially more vulnerable. In my case, all my conversations are confidential unless, for example, two doctors indicate that they want to have me serve as the facilitator to help them develop their relationship and work through written terms. In that case, when I talk with one about a term(s) I will email or call the other to keep the process moving until the next three way conference call takes place. So, unless you request me to share our discussions, you can be assured that our conversation is private. But note, in providing a consulting service there are no specific rules of confidentiality. I must say however, if I shared confidences in the very small community that is, in this case orthodontics, I would not be practicing in this my 26th year!" In short, be careful with your confidential information and know who you are discussing your affairs with. Don't just assume that your confidences will be kept, instead just as this wise doctor did, ask and discuss your expectations regarding confidentiality.

"From Nordstrom to Wal Mart"

A long established doctor recently sold his practice to an energetic younger practitioner. The seller had an established reputation based on the care provided, personalized attention to patients and a business format provided by the excellent front desk staff. It is approximately two months since the practice transfer. Despite the seller providing suggestions, a guide to policies and procedures that have helped the success of the practice over the years as well as and daily experienced based perspectives to the purchaser, the practice is in upheaval. The seller received a call from a long time employee at home recently that was shared with me. The employee related that almost all systems are being changed, the schedule compacted and many other changes. The employee noted that one adult patient stated "the practice is being changed from a personal Nordstrom type caring environment to a more performance based Wal Mart type" environment. Every doctor has a right to develop and present their practice as they see fit. In CEO parlance this can be seen as a part of branding and also of course marketing. In the health care context it also relates to the subtle indicators of more or less doctor attention and care. One of the things this purchaser bought was the goodwill of the patients, a portion of which as the expectation that patients would return for care as needed. But care can be secured in many places today and big changes are often not welcome by patients. My view is that it is too drastic for this new owner and CEO to switch the practice to a very different brand so soon after the transaction and he will pay a price in lost patients and production.

Is An Attorney An Attorney For All Matters?

Three times in one week the same question came up with different doctors. I just have to vent my viewpoint, shared with all three and now for all my blog readers. Here's the question, in a modified form, asked by all three: "I know this is a transition of my practice and I also have some estate issues that need attention and I want to sell the practice facility and real estate, can't I just use the same attorney?" The simple answer is "yes", but also "no". Each of the areas mentioned above, transactional, estate / tax and real estate is a separate area of law, with of course overlaps. But the degree of sophistication required today to effectively and efficiently provide legal services in all those areas by the same person takes, in my view, an exceptional attorney. My experience has been that doctor CEOs are overseeing ever more complex practices with significant legal issues and they need expert assistance. I personally like to encourage that experienced and comment counsel with a working background in the needed area of the law be used. So even though you may need two or three attorneys for your affairs it is in your own best interest to have an expert in the given legal area on your team

Should A CEO Doctor Play Jokes On Staff?

One of my clients asked this question in light of the protracted and costly case, Woo vs. Fireman's Fund. The case was recently decided. Dr. Woo, an oral surgeon, decided to temporarily place in an assistant of his, Tina Alberts, fake boar tusks and then photograph her while she was under anesthesia in his chair. She brought suit against Dr. Woo, based on malpractice and invasion of privacy. Dr. Woo wanted his malpractice carrier, Fireman's Fund, to defend. They declined indicating that they had no duty to do so, because the dentist's conduct was outside the normal scope of dental practice. A a state appellate court and four supreme court judges agreed. But, on July 27th a majority of the Supreme Court of Washington sitting En Banc decided in Dr. Woo's favor. The Court reasoned that because Dr. Woo's conduct was "conceivably" within the realm of dental care, the insurer had a duty and should have covered him under his professional liability policy. The Court reinstated a $750,000 jury award to Dr. Woo, which also included a $250,000 settlement he paid the assistant. My response to my client was that, "No CEO in a health care setting should play a practical joke on any person, patient or staff, when that person is under anesthesia." Further, in today's more circumspect practice environments with staff of different ethnic backgrounds, ages and perspectives on appropriate vs. inappropriate behavior, great care should be taken before any joke should be played on staff. See Robert C. Woo, DDS, and Anne M. Woo vs. Fireman's Fund Insurance, NO. 77684-9, July 26, 2007. Read also David Ammons, Associated Press story July 27, 2007, 10:39AM

Are You Challenged By Confrontation?

Many doctor CEO's direct substantial practice enterprises with literally dozens of employees, vendors and outside service professionals. Yet, size seems to make no difference in one of the all-time management difficulties: avoiding a confrontation. In smaller practices generally either there is a resolution with a discussion / confrontation or the employee, vendor or professional firm is terminated if the matter can not be resolved. In contrast, in larger environments, it can be easy to avoid the discussion altogether by hiding or delegating. In some cases we are familiar with the CEO has raised to an art form the avoidance of resolving with direct conversation the irritating or problematic situation. What is often not accounted for is the emotional cost of not resolving the situation. From a practice administration and emotional standpoint, we find that it is always better to resolve the difficult situation or personnel matter than to let it fester.

The Roar Gets Louder

It is common to come across doctor CEO's who have loved their practices and invested themselves totally. To the point that whole decades go by. One recent client email stated, "I cannot believe I have been in practice for over 28 years. Where did the years go?" The unusual aspect is the doctor CEO who plans early enough, though late in their career, to effect a beneficial transition. Although most doctor CEO's are pressed with day to day practice and personal activity to the point there can be little time left, the roar of the coming end of practice gets louder. Today, as never before with larger and more sophisticated practices it is imperative for doctors to plan sooner rather than later for a potential transition. What combination of transition/succession options fits best for the practice and doctor? Is it an associate and then a sale? Is it a partner with a planned buyout? Is it an immediate sale? Any hire back period for a founder? All of these aspects and others need to be reflected on to design the optimum approach for each doctor CEO.