Of human capital theory and you

Take “invest in yourself” literally.

At times we need to defocus investments on material capital and redirect energy to investing in human capital.

Economists look at the scarcity of resources to determine how a practice is able to supply care in the community to meet a demand. This classic “supply and demand” model in a professional service industry, such as ophthalmology practices, is dependent on a single key factor: the physician and staff. Thus, a practice needs to analyze and strategize how to best care for the people working in the practice — including you.

Left: Randallstown High School with Aaron Wolf in 1986. Right: With Aaron again in 2017 at the Chicago Triathlon, two-minute pit stop, minus the dog, for selfie.


In the early days of building my practice, I recall standing in the back tech station, reviewing my next patient’s chart and complaining to the senior partner that emergency patients were added every day. Further, I grumbled, “I’m always running behind, barely getting lunch and finishing later than expected.” He looked up from his chart and said, “It’s your fault. You have control and choose not to use it.”

At the time I didn’t understand how I contributed to the situation. But over the next couple days, I kept remembering his words as my practice became more like work. They ultimately led me to take ownership of protecting my practice’s greatest asset: me. If I was becoming rushed, short with patients’ questions and frustrated with staff each day, my ability to grow a practice would quickly decline. Additionally, I knew at the end of my career I wouldn’t remember how many patients I saw, or number of surgeries performed, but rather my personal experience while at work.

I realized that if I wanted to enjoy each day and spend more time at home with family, I had to stop running late at the office. So I invested time in creating an environment for greater success — and less stress. To solve the problems that had triggered my initial complaints, I created slots for emergency visits, had a technician triage patient concerns and added appointment slots for urgent one-week follow-ups. I even finally realized I needed to stop seeing patients earlier on Fridays because there were always extra add-on patients that day.

And since I hated clicking a mouse all day to record data and write plans, I added a scribe to my staff. This addition allowed me to have more eye contact with patients and to stay in the room in case a patient needed instructions a third time on how to use a drop. Of course, these changes had costs — at first fewer patients were seen, and we needed to spend time in meetings to create the changes and then implement the new policies. But it was well worth it as I regained control of my workday.


It seems so obvious to protect others from burning out. Certainly we obsess over our kids, making certain they have balance in their lives — a healthy lunch each day, scheduled activities that leave enough time for homework and lastly, that they get enough sleep. All this so they can be happy and do their best.

It is interesting that we are not as careful to do this for ourselves. At work, we are quick to analyze the cost and benefit of material capital, like the purchase of an OCT or fundus camera. But this cost-benefit consideration impacts your practice on human capital too. A doctor or staff member who is not overwhelmed will interact more positively with patients, and will be more productive and efficient as well. And through that positive experience the patient will also contribute to practice growth. The investment of time and even money on the human capital of your practice will have a direct impact on the physical means of production.


As a practice grows, our instinctive response seems to be to double-book patients and hire more staff. But investing in your current staff will create a corporate culture with exponential returns. For example, hold workshops to discuss how to best handle tough patients or add-on patients. Have someone in the office ensure that everyone gets at least 30 minutes for lunch each day and if running late, permit some staff to leave on time. Have the office go on a field trip or schedule a nonmedical motivational guest speaker visit. How about a team-building activity such as laser tag or a visit to a “breakout room”?

Offering to pay for continuing education, such as COA courses, will build confidence and loyalty. It may seem impossible to close the office a half-day or pay tuition fees for staff, but these things will yield greater productivity — and peace — over the long term.


Three hours and 74 seconds. I aimed to complete a triathlon this past summer in Chicago in under three hours. To prepare, I woke before dawn to swim before work and did extra track practice at the local high school on weekends.

The big day finally came and, after four months of training, I was running well; my preparation was paying off. But a friend from high school who lives in Chicago and whom I haven’t seen for many years came out to watch the run. I saw him from the pack and stopped during a two-minute pit stop to greet him, take a selfie and even meet his dog.

My Garmin watch beeped the entire two minutes. But the time I was racing against no longer mattered — I was grinning as I finished the triathlon despite being 74 seconds over my goal. I didn’t break the three hours that I’d worked so hard to achieve, but I cherished the extra 74 seconds I spent visiting an old friend.

Our practice’s mantra is “Each day there will be fires,” so when they happen we are neither startled nor frustrated by them. Our buckets can only hold so much, so we must make conscious decisions on managing our time and well-being. Our practice depends on our self-commitment to this investment. Failing to analyze and invest in your practice’s human capital component will negatively affect its overall economy. OM