I joined my father’s practice my first day out of residency. Many would think this is a match made in heaven — and while it has been rewarding for both parties, our relationship has been tested. It has certainly been more contentious at times than either of us would have desired, but we have persevered and become better people for it. Failure wasn’t an option for us with regards to family and relationships. But, the daily strain of each party wanting his own way has definitely proved a test to our patience.
I joined a practice with four offices, two ophthalmologists and four optometrists. Over the last three years, I bought into the practice and the surgery center with the help and guidance of BSM Consulting. The practice sits today with eight offices, more than 110 employees (up from the approximately 70 when I joined), nine optometrists and three ophthalmologists. We have an elite CEO, Ray Mays, and an elite COO, Erik Bergvin, who work seamlessly together to direct the future of the enterprise. These two help run the practice with the same commitment to the company’s mission as the owners. We are still a locally owned and operated practice, and we have no desire to deviate from this model despite the new drive for private equity.
Many ask me how we have grown to this size and maintained our sanity. Isn’t there a breaking point? The secret lies in many of the principles my father taught me about private practice as well as some newer thoughts from good advisors. It is always important to be on the lookout for good mentors, to gain experience from those who have walked before us.
Below, I describe my 10 pearls of practice partnership.
1. BE UNDERSTANDING AND ACCOMMODATING.
“People are always the wildcard,” as my COO says, and just when you think you have someone or something figured out, it changes. Understanding different perspectives can really set you up for success further down the road.
Typically, when you arrive at a new practice where you want to make partner, you will not agree with every decision the senior partner is making. However, if you knew the senior partner’s perspective and experiences, you might realize he has a method to his madness. This was certainly the case with my father and me. He helped explain and show me his reasoning for building the practice a certain way and subsequently allowed me to not make the same errors he had made.
One particular lesson I remember is him showing me to encourage employees to be involved in practice decisions. This lets them feel involved and invested in the practice and avoids the feeling that the doctor is the only one making decisions.
The same will apply when you acquire a new practice. You are not just buying hardware and patient records — you are joining a culture and staff that has been built over a number of years. When assimilating the acquisition into your practice, accommodate the new staff members’ traditions or culture and be understanding of the changes they are experiencing. Giving staff time to adjust to these changes will not go unnoticed and will help create “buy in” further down the road.
2. BE FLEXIBLE WITH CHANGE.
With our country’s revolving door of politicians and endless promises from both sides of the aisle, health care oftentimes finds itself in the middle of change. For you to remain relevant, you must adapt to an ever-shifting environment.
While in residency, I was taught a certain methodology. Once out in private practice, I had to be flexible and learn how my new practice operated. Being a bully with your own way is not a wise move. Trust me: I made that mistake early on, and I regret it daily. The worst decision you can make for practice growth is becoming complacent or stagnant. Not growing or adapting to your environment is a recipe for disaster. Never forget these words of Robert C. Gallagher: “Change is inevitable — except from a vending machine.”
3. BE DILIGENT IN YOUR CONTRACT.
Physician and partner contracts can be very laborious. Taking items or wording personally is oftentimes a recipe for disaster. Most items can be negotiated, and you might be surprised to find both parties agreeing on a point that happened to be overlooked earlier. Still, you should find a good attorney to help with the contract process and ideally a colleague who has experience in similar negotiations and can offer advice.
Be as emotionally detached from the negotiation as possible. The worst thing you can do for the health of your future practice and partnership is take everything personally from the initial contract. Typically, your future partner is not out to get you. This person truly wants you to succeed, so do not use emotion in your decision making.
You also need to ask yourself where you want to be in 5, 10 or 20 years. Do you see yourself owning part of the practice, taking on a more administrative role, or being an employee? Each direction has its pros and cons. Not knowing where you want to go or who you want to be at the end of your career can make the buy-in that much more challenging.
4. BE PRODUCTIVE BOTH IN AND OUT OF THE CLINIC.
Work-life balance is a must to stave off burnout. But, many people these days desire to essentially do nothing and make a lot of money, which does not happen unless you were born into money.
To make your partner happy, become as productive as possible. No partner is unhappy with someone helping them make money, but many disagreements begin when one partner just wants to golf while the other partner works his tail off.
I recommend finding ways to benefit the practice outside of clinic. This could include being present and showing kindness to others in the community or at dinner events. These good habits will go a long way with your partner; remember that you represent the practice everywhere you go, whether it’s a formal dinner or the local fast-food restaurant. Always have your “game-face” on, and be professional.
5. BE CHARITABLE.
The most important thing you are going to do in life is leave a lasting legacy for your children and family. Not a single person has ever died without helping others and being remembered fondly by someone. Every few months, my CEO says to our management team, “Pigs get fat, hogs get slaughtered.” It is a reminder that becoming obsessed with making money and trying to get it all yourself will lead you to ruin.
If you are not involved in a church, foundation or community outreach, do it. This allows both partners to feel good about doing the right things in life. “A generous person will prosper; whoever refreshes others will be refreshed” (Proverbs 11:25).
6. BE EVER IN PURSUIT OF EXCELLENCE.
Excellence is not a metric that can be hit day in and day out. You must always adjust and expand your thinking and be in pursuit of that elusive goal. Being stagnant and closed-minded does nothing but hurt the practice and everyone involved.
Seek out new ways of business, and embrace technology. Oftentimes, administrators and owners find themselves unable to remove risk from an equation. Projects that are not accompanied by some degree of risk are oftentimes not worthwhile. Risk is always subjective and not two-dimensional. We can also dilute risk to lessen its impact throughout the company.
7. BE RESPONSIBLE FOR YOUR PATIENTS.
The new way of life seems to be doctors assuming less responsibility for their patients and co-managing everything. While this isn’t entirely bad, I recommend that you do not dump patients on your partner. You are responsible for your patients and making sure they have the care they need. Certainly, you will need assistance at times, but you still must be present for your patients.
The Hippocratic Oath states very clearly, “First, do not harm.” This is important to remember when it comes to partnerships as well. Do your best to take the most ethical route for patient care. This will lead to a happier partner who trusts your care with his patients when needed.
8. BE WILLING TO COMPROMISE.
Realize that your way isn’t always the best way in accomplishing a goal. This is a hard pill to swallow for most doctors, but keep in mind that it is not always your fault; schooling, your title and your responsibilities often put you in a position where you must make a snap decision, even when it’s not always the best one.
Not every question needs an immediate answer. To ponder an issue and ask for opinions from others can generate a better result. Truly, I am not good at this, but I am trying very hard to understand it is better to have two people working together than one person dominating everyone. Having self-control and practicing self-awareness helps in all aspects of life: at home, during negotiations, dealing with staff and more.
9. BE WILLING TO UNDERSTAND FIRST, AND BE UNDERSTOOD SECOND.
Be the last to speak. Seek input from those around you; oftentimes the closest person to the action has a different perspective that you have not thought of yet. Many crises have been adverted by simply speaking with the staff closest to the issue.
The worst thing you can do is make assumptions of others during times of adversity. My father always tells me that no one is guilty just because of an accusation. This is incredible advice. Be willing to understand your partner, or at least try to, before making them understand your rationale.
10. BE FORTHRIGHT AND TRANSPARENT WITH YOUR DESIRES.
To me, the most important last step in this process is making sure the other partner or partners understand what you want out of life. I love hearing new graduates say, “I just want to be a high-volume surgeon.” They really do want that, but what they really want is someone to give them those cases and not have to grind it out for years to get to the glory.
For folks trying to join partnerships, I always recommend them to be honest with themselves and find out what they desire in their practice. If they want to be high volume, then by all means go get it. But, make sure you understand the meaning of that and what the risks are that come with it.
Be open with the partners about your goals to expand or remain the same. No one wants a partner who goes completely rogue and wants to do his or her own thing. Meet regularly with your partner or partners. Express your desires, be transparent and watch the wonderful world of private practice partnerships come to life.
Over the last few years, I have really learned a lot about partnerships, corporations, solo-practice and LLCs. My journey has led me down a path of self-examination and practice exploration, and I’ve had the time to reflect on what I’ve learned: “The rear-view mirror is always clearer than the windshield,” as they say. While I can’t share every “pearl” I’ve experienced in one article, if the tips above can help just one person through this process, then it has been worthwhile. OM