The EntreMD Podcast
Dr. Una is passionate about helping physicians embrace entrepreneurship so they can grow their wealth and win back the freedom to practice medicine on their own terms. Learn more at: https://entremd.com/. Dr. Una helps physicians build and grow their businesses to 7 figures and beyond. Each week, she will share key insights on how you can turn your medical experience into a profitable, passion-based business that gives you time, freedom, and a deep sense of purpose. Be sure to follow the podcast so you never miss a new episode!
The EntreMD Podcast
The Complete Turnaround Strategies for a Private Practice in Crisis
Are you a private practice physician feeling crushed by high overhead and low revenue? You’re not alone—and you don’t have to stay stuck. In this episode of the EntreMD Podcast, I’ll show you the proven steps to rescue your practice, lower costs, boost revenue, and finally build the thriving business you envisioned when you started.
You’ll discover the mindset shifts, practical strategies, and systems that will help you go from survival mode to profitability and peace. Whether you’re just starting out or you’ve been in practice for years, these principles will help you turn things around—fast.
Additional Resources:
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- Grab a copy of the "The EntreMD Method" book.
When you are ready to work with us, here are three ways:
- EntreMD Business School Accelerator - If you are looking to make a 180 turnaround in your business in 90 days, this is the program for you.
- EntreMD Business School Grow - This is our year-long program with a track record of producing physician entrepreneurs who are building 6, 7 and 7+ figure businesses. They do this while building their dream lives!
- EntreMD Business School Scale - This is our high-level mastermind for physicians who have crossed the seven figure milestone and want to build their businesses to be well oiled machines that can run without them.
To get on a call with my team to determine your next best step, go here ...
Hi docs, Welcome to the EntreMD podcast, where it's all about helping amazing physicians just like you embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms. I'm your host, Dr Imna. We have a doctor in private practice who has a practice where her overhead is so high, her revenue is a lot less and she thinks that her private practice is at risk of failing.
Speaker 2:And so today, what we're going to do is take a look at this practice, come up with a diagnosis, fix the practice and give this doctor a strategy she can start working with and, right away, start seeing wins in her practice and, over time, bring it from a place where it goes from almost failing to completely thriving. Okay, so we're going to look at this private practice. This is going to be a lot of fun If we haven't met before. My name is Dr Una. I'm a pediatrician by training. I have been in private practice for the last 15 years and at this point I've technically exited my practice, if you will. My practice is team-led and it's been that way for the last five years. And then I'm the founder of EntreeMD. I help doctors build profitable businesses so they have the freedom to live life and practice medicine on their terms. I am a huge advocate for private practice. Private practice is not dead. The old playbooks are and, yes, we have a lot of systemic problems in the healthcare space. But until we have enough empowered physicians who can then stand up to the system, we are going nowhere. Okay, so I fully understand there's a lot of things to fix, but you know, when you get on a plane, they tell you, if the pressure goes low, oxygen masks are going to come down. You're going to put it on yourself first and then you're going to put it on others, okay, so this is us putting the oxygen mask on ourselves, okay, all right.
Speaker 2:So when this doctor told me this, I said okay, I want you to think about the top five things that are creating this financial pressure and financial challenge you have in your private practice. And she sent me these five things, so we're going to troubleshoot these five things, okay. So the first thing was you know my reimbursement right from the insurance company. So this is insurance-based. Private practice is low and slow. Okay, so it's low and slow. Money coming in, and we know money coming in. That's like the blood, if you will, of the private practice and all of those things. So this is something that we absolutely need to fix, okay. So she gave me some context. She said there's a large discrepancy between insurance carriers, and so you know. So some pay you know well and some pay very poorly. She said I've already stopped taking Medicaid. There are thousands of outstanding dollars after the first year with Medicaid, and then it's considered letting go of TRICARE. Okay, and again, because of low reimbursements and all of those things, and so this is something that absolutely needs to be fixed. When you think about the practice revenue, anything touching it is like something touching your aorta, like once you bleed from there you're bleeding out, right. So this is something very serious. We want to look into it and we want to fix it.
Speaker 2:So I came up with some recommendations for her. Okay, these are things that she can consider. These are things that she can do. Some of them will work fairly quickly. Some of them will work over time. I don't think that any of these strategies really that she shouldn't employ.
Speaker 2:Okay, so the first one I said is looking into joining a network that manages contracting. Okay, so, like an IPA, an independent physician association, or PHO, a physician hospital organization, you know, like one of these, and this is if she's not already a part of it. And why is that? Well, because these organizations have a pool of physicians within them. They're usually able to negotiate for better rates. Okay, so there's so many people who have had significant bumps in their revenue just because they went from contracting directly to contracting with an IPA right Now. So if she hasn't done this, this will be a really great thing to consider. Chances are that it's not going to bring an immediate turnaround, because it's going to be a process to go through them and all of those kinds of things, but it's something that, yes, it will bring a lot of transformation.
Speaker 2:Now I will say with this, because it has to do with your money and the entire revenue of your practice, you do want to choose carefully, right, everybody's going to sell you a good game. They're going to say, when you come on, we'll do this, we'll do that, blah, blah, blah. They'll make all the promises in the world and I'm going to challenge you to find three to five people who are using that IP or using that PHO and go find out from them what the real deal is. Right, so you want to get references. It doesn't have to be from the company. It can be from the company or the organization, or you can get them directly like who's part of this network, who's part of this network? And you go interview and have real conversations.
Speaker 2:Okay, do not take anything at face value. This is something that we do as physicians and something we want to walk away from doing. Okay, something we want to walk away from doing, which is, whatever they said, we just believe them, don't. You're an entrepreneur now. That's not what we do. Trust, but verify, right. Okay.
Speaker 2:So that's the first recommendation for reimbursement being low and slow. The second one is to audit the distribution of patients and insurance in the practice. Data is a very beautiful thing because data will show you like data preaches to you. You see, the data automatically becomes obvious what needs to happen, right. And so you want to think like what are the top three insurances my patients use? You want to know what that number is. You want to know what those insurance companies are. You want to have a feel for it. But, more importantly, you want to know, like, based on the fee scale, you want to organize them from best paying to lowest paying, right.
Speaker 2:And then you ask yourself a question for the lowest paying ones Am I even making money on them, or is every? Do I lose money with every visit Because we've had to drop some insurances because they would pay us lower? Or the exact amounts that the vaccines cost? And I'm like, if you pay me the exact amount that the vaccines cost, I am losing money with each vaccine I give because I have to buy the vaccine, I have to store the vaccine, I have to pay staff to process the vaccine, I have to do all of these things and so, yeah, and we have vaccine wastage. I'm losing money on that. And so you are an insurance company that is too expensive for me to be in network with, like you're too expensive because you cost me money, right. And so you have to look like, am I losing money? Or I'm just not getting as much? Like, what is it right? If you know like, and then you want to consider dropping some. If you need to drop them, right, if you need to drop them because it's a business decision. But you want to look and then you find out that most of your patients are with a very poor paying insurance company, then the question then becomes do I close the panel and market really hard and change the distribution?
Speaker 2:Now, this doesn't mean change the philosophy of your practice. For instance, my private practice is 60%, is about 60% Medicaid, and at a point it was even higher. And I'm okay with it because that's what I wanted. I, you know, I wanted a practice where I could people who had really good insurance and people who had Medicaid they, you know, they could come, they get treated really well, they have a great experience. They have access to a doctor. We had same day appointments, we had like all kinds of fun stuff. I wanted them to have that.
Speaker 2:Now, what it means is I was also aware that I was playing a volume game. I, you know, like I didn't lie to myself. You can't say I want to take Medicaid and I want to see one patient an hour. Those two things cannot coexist. The business will die. It will die a sure death, right. And so I'm like okay, I want to do that. So the question then becomes how can I go through the volume and do it in such a way that it's still a very personalized experience where they felt like they were heard and all of that?
Speaker 2:Then I had to come up with the strategies for people to have a great experience, even though then I'm not sitting with them for an hour. Do you see what I'm saying Like? So it doesn't mean find the people, drop everybody. That's not what it means. But if you don't have the data, you don't know. So I have 10,000 patients, wonderful Top three insurance companies used by those 10,000 patients. You want to know what that is. Then you want to have the insurance companies top to bottom, from best paying to lowest paying and lowest paying is it lowest paying, like I'm making a little profit, or is it lowest pain, like I'm losing money? If you're losing money, you got to drop them. You got to drop them. Okay, all right. So that's the second thing we want to do, this audit of the distribution.
Speaker 2:The third thing for this person, because her specialty lends to it, is I'm like, but you want to consider some cash-based services and chances are, this doctor has either been thinking of it or maybe has some cash-based services, but they haven't necessarily been promoted and stuff like that. And the reason why I brought this up because, with what this practice is going through, it does seem like having an immediate cash injection would be really good for the practice, and so if they're cash-based verticals that already exist, we want to go hard on those. If they don't exist I mean for this person's specialty there are many that can just exist. They can start today because this person is equipped to do them. They're hot topics, all of those things, so they can do them.
Speaker 2:Why Immediate cash flow and higher margins? Right, because you don't need the bill or you don't need this. There are a lot of things that you don't need, so I would do that because and someone may say, oh, but this is so businessy, we're just going to bring these services because of the cash. No, we're going to bring the services because it'd be high value to her people and it will bring cash. And if you're in private practice, I don't want you to continue to be thrown off by the need to make money, because for your practice to stay open, you need to make money. We need to stop pretending, we need to stop acting like this is not an important thing. I am fully aware that one of the best ways I serve my patients is by staying profitable, because if I'm not profitable, I have to go away. Okay, okay, so that's that's.
Speaker 2:The third recommendation is to lean into some cash-based services. Okay, again, cash injection, because this practice, we need to get cash in. The fourth thing is I would prioritize services that increase the cashflow, and I'll explain what I mean by that. Okay, so let's say, for instance, in my private practice, if we say, oh, it looks like the next two weeks that we have open spots and stuff and we need to do something to fill our schedule, so we need to be proactive as opposed to reactive. Okay, and I have.
Speaker 2:Let's say, I have 300 patients who are overdue for well checks. Okay, now I know that I can't see all 300. So what are we going to do? We are going to call the people with the better paying insurance and we're going to get them in. What is that going to do? It's going to give me a better cash flow.
Speaker 2:Now, you might say, but what of all the other people? Well, in my practice, we happen to have a routine schedule for sending out reminders to make appointments. So they have all had reminders, every last one of them. Okay, we also do not let people leave the office without scheduling appointments. So for them not to have an appointment, it means that they canceled the appointment or they no-showed for an appointment and we have not been able to reach them. Okay, so are we reaching out to everybody? We are, but if I want to go hard and put staff time behind bringing people in, I am going to leverage what will be a bigger win-win situation for all of us. Okay, all right.
Speaker 2:So for this doctor, you have to be aware. You have to be aware. The services that I offer, top to bottom, from biggest revenue generator to least revenue generator, do you do all of them, sure, but in a situation like this, where we're like, oh, my goodness, something needs to give, you want to prioritize those. You're available for everything, but you prioritize those, okay, all right Again, if this makes you feel like, but it's about the patient, of course it's about the patient. That means you're treating people differently. No, no, no, no, we're not, we're not. But seeing patients is the responsible thing for a doctor to do, and keeping the practice profitable is a responsible thing for a doctor to do. They're both responsible things. So we're doing both. Okay, all right. The fifth recommendation there I have is maximize daily productivity. Now, this is so, so, so, so important. Okay, I will give an example.
Speaker 2:I was talking to a doctor, someone that I really have a lot of respect for, and all of that stuff. She's running a practice, she built it from scratch, she's doing an amazing job. And then, while we were talking, she says you know, I don't want to get burned out. I want to see a certain number of patients every day, you know, because that's what I want to see. Okay, and then I said so. And then she went on and I said wait, wait, what is that number? How many patients do you want to see and I asked this question because I know she's an insurance based model and so she says I want to see 14 patients a day.
Speaker 2:No, your reimbursement is probably not more than $150 per visit. So I'm like, okay, we're going to do some math here. Okay, so 150, I didn't use 150, I used 100 on that day because the math was easier. But let's do the real math. Okay, 150 times 14 is 2100. So I mean that your cap with you as the doc there, your cap is 2100 a day. Okay, and you multiply that by 260, you're at $546,000. Now when I did the math with 100, it was $364,000,. Okay, so you're at $546,000 before overhead. That's the cap. If your practice is like 60% overhead, which is not unusual, your 60% overhead puts you at 327,600.
Speaker 2:So the question is then becomes what's left? Right, what's left? So this is what we need to look at. You have to know what the numbers say. You have to know what the numbers say. So when I did it with her and did the math at a hundred, I said you're at $364,000. That's the cap. That's the most your practice can bring in before overhead. Before paying you before any profit, you have to be sure that you're okay with that number.
Speaker 2:You see what I'm saying. So for this doctor, I would actually have her look like look back on the last two weeks on the last month. How many patients are you seeing every day? Look back on the last two weeks on the last month. How many patients are you seeing every day? What is the maximum amount of revenue you can create with that? Are you having more no-shows than you thought? Are you seeing less volume than you thought? With the volume that you are seeing, what is the max per day? Because if that max per day is a number that you don't want, something needs to give. Do you see what I'm saying? If we don't do the math, bad things happen, okay. So this is part of the reason why we use in my private practice, we use Practice Pilot, okay.
Speaker 2:So Practice Pilot is a financial tracking software for private practices and when you create, when you go in there, one of the things you would do is it will have you put your average reimbursement per patient, okay, and then you create, when you go in there, one of the things it would do is it will have you put your average reimbursement per patient, okay, and then you will set what your goal is. So if you say my revenue goal for this year is I want to bring in 2 million, now, based on your average reimbursement per patient, it will tell you how many patients you need to see. And if you say, no, I don't want to see that number, I want to see this number, it will show you how much revenue you can generate. And once you see those, there's just something about seeing the data that lets you know like, wait, I don't like that number. And then, if you don't like the number, the average reimbursement needs to change or the volume of patients needs to something, something needs to give. Okay, so I would have this doctor do the math with the way you're functioning, what is the potential amount of revenue your practice can bring in every day? This is a number you want to know. Okay, all right.
Speaker 2:So that was the first thing. That was the first thing. My reimbursements were low and slow, okay. Second thing my AR is out of control. Okay, my AR is out of control. So when we looked at this, okay, this was the number, this is the number that she gave me. Okay, she said over over 90 days. So from from over 60 days was almost 80% of her revenue. 90 to 120 days was 38% of her revenue. She has a lot of revenue sitting in her AR, a lot of it and for older practices you may have that because maybe you have bad debt from years and years and years. So you're over 120 is bloated. She's in her second year. She's in her second year of practice, right, and so to have that number, I would definitely make the assumption that my biller is not doing a good job. You can even make the assumption that maybe your fund desk people are not doing a good job, maybe the insurance eligibility, I don't know. But there are things that you're going to. Okay, we need to look here Now. So these are the recommendations I have based on that.
Speaker 2:First of all, I'm like you have to treat this as a matter of urgency and I would think of it like somebody's bleeding out. You're a surgeon, you have somebody on the operating table and this person is bleeding out. Nobody's like calm and collected and whatever. Like we have something to fix. Okay, so we're not frazzled, but there's urgency. Okay. When you have AR like this this early in the game, there's urgency. This needs to be fixed. It means the practice is bleeding out. What that means is you know we have this thing of if we're seeing a lot of patients, that means you know if we're really busy, it means the practice is working. No, no, no. The evidence of the practice working is in the bank account, because the fact that you saw a patient doesn't mean you got paid for seeing the patient. It doesn't mean that at all. After seeing the patient, there are processes that need to happen before you get paid. So this is what I have for her Treat this as a matter of urgency.
Speaker 2:Treat it like there's somebody in the OR on the table bleeding out. If you know the level of urgency you have with that, you're still calm because you have the strategy. You know the algorithms and all of those things, but it's urgent, it's urgent. So one is treat it as a matter of urgency. Two is meet with the billers to diagnose the issue and create a strategic path forward. What that means is you're not even offering all the things when you have a vendor. Please understand that the vendor works for you. Okay, they may not be your W-2 employee, but they work for you. And so you sit with them and you're like okay, we have an issue. Okay, this is what our billing looks like. This is what the national standard benchmarks are. So somebody walk me through what exactly is going on Like, what is the core issue here? Okay, the core issue here? Okay, it can be more than three. What are the top three? What are the three core issues here? Or the one core issue here is usually not one, so let's say three. And what is the strategic path to move forward? How do we make this AR look like this AR, like this national benchmark?
Speaker 2:Okay, now, billers have been known to blow hot air because they know physicians don't care about this stuff, physicians don't want to look at this stuff, physicians will not ask questions. I literally had a client who talked to her biller like I want us to meet and do all this, and she's like no physician's ever asked to meet with me. I was like, ooh, we're in the on-term deal world. Of course. We ask this is the era of the practice, right? Okay, so what is the issue? And when they tell you highfalutin things, you're like, break it down, break it down. Like I'm a doctor, like I'm a third grader, like make it make sense, but don't just accept anything, right, don't just accept anything. The diagnosis needs to make sense to you. The strategic path forward needs to make sense to you, okay, so have them come up with it. Create a strategic path forward. You want to lean into it? So I've taught about this in the profitable private practice movement, like you know how to look at these things at all. You want to look at it? Okay, all right.
Speaker 2:Then the third thing is after you're done with that meeting, things will change. If you do this thing, which is to meet with them weekly, give them the gift of accountability. This is where we were last week. This is where we are this week. These are the plans that we made. These are the problems we identified. What is the update? What is the update? This does not need to take more than 30 minutes, but that 30 minutes will be at the equivalent of thousands and thousands of dollars. If you do it, and if you don't, everybody will forget it and go to the status quo. Everybody, including champions, need the gift of accountability, right, and so you meet with them weekly to at least you slow down the bleeding, right? Okay, so that's the thing I would do, absolutely Okay.
Speaker 2:Number four I would hold the biller. So she has a biller, like her EHR company does the billing and then she has another person to assist with the billing. Okay, I would hold both accountable. Okay, I will hold both of them accountable, to whatever metrics and all of those things. I would even hold the front desk accountable. If they're not verifying insurance eligibility, collecting co-pays Like if your personal AR as opposed to your insurance AR is also really high, I will hold them accountable. Like, all co-pays need to be collected. All co-insurance needs to be collected. All deductibles need to be collected, all balances need to be collected. I want you to start thinking about your front desk person as your director of finance. Their job is to collect money, because your practice is in a place where you need like, everybody needs to collect money, but for this practice in particular, they need to collect money. They can leave no money on the table none.
Speaker 2:Okay, then number five is long-term. You have to look. Do I need to start looking for a new billing partner? Do I need to look for new billers? Okay, because if you're working with billers and they're not making the changes, they're gaslighting you. It's the same thing over and over again. They're not getting any sense of urgency or whatever. You probably need to work with them to do what you need to do in the moment, but if you know you're going to look, then you want to start looking, because that's a whole process on its own.
Speaker 2:And again, I would tread carefully. I would not roll over my billing to a new company without interviewing people who are using that new biller and want to go with hearing their real experience, especially if they're people who know what their numbers are. Sometimes people are like, oh, that biller is great. They've never met with them, they don't know what the AR is and all that. It doesn't matter. So you want to talk to somebody who, like you, is looking into their numbers. They know what it is, they know their billers, are good at this and all of that kind of stuff. Okay, I would say, long-term, start looking for new billing partners if you need to, okay. And again, a financial tracking system like you know, practice pilot is probably a good system for you to keep your numbers in front of you. You can see it as a simple system. You can log in every day, see what we're doing with money, let's see what our potential revenue is, look at what our AR is looking like and all of those things, okay, okay.
Speaker 2:So that was the second problem. First problem reimbursement is low and slow. Second problem AR is out of control. Third problem high overhead. Okay, now, I didn't get all the details of the overhead, but, for instance, her rent is $9,500 a month. Right, that's $120,000 a year, almost, Okay, all right. So we have high overhead in the midst of our low and slow reimbursements, okay, and our AR being out of control. So we have inflow problems and we have outflow problems, okay. So what would I recommend? She does Right, so this is a high rent, it's a high lease and, by extrapolation, our overhead is just high, okay.
Speaker 2:So one is consider subleasing, and one of the things that happens when we have really big things that we need to work through is that our mind offers up this thought of it's not possible, you can't, it's not possible, nobody does all of that stuff. You're an entrepreneur now, right, so everyone watching this, and so what that means is there are very few things that are, we don't start with, impossible. So we don't say I can't do that. We say how can I do that? This is such an empowerment question. How can I do that? How can I pull that off? How can that be possible? How can?
Speaker 2:Okay, so, have human beings subleased? Yes, yes, millions of people have subleased. So, okay, how can I? Right, oh, but the landlord said I can't sublease. Okay, does he want that? Or does he want a private practice? That's not there at all and can't pay him money anyway? I'm paying you 10 grand a month. Man, help me figure out how to help you. Okay, and so, yes, so can it be negotiated? Yes, can we find a tenant? Yes, we can. We simply can. Okay, all right. So, especially if you're not using all this space, oh, my goodness, because you can reduce your rent by $2,000 a month if you can find somebody who sublease for $2,000 a month. Okay, so that's a thing, and I would work it. I would work it. Okay, I would tell the people in my network, I would have my team talk to people, I do all kinds of stuff, okay.
Speaker 2:Second thing is reduce non-essential, non-revenue generating expenses, and so what that means is you're going to pull, for instance, your bank statement, your credit card statement, all of those things for the practice, and you're going to go line by line. Okay, is this essential to the running of this practice? Does this create revenue? Is this essential to the running of the practice? Does this create revenue? Is this essential to the running of the practice? Does this create revenue? Is this essential to the running of the practice? Does this create revenue? And if it doesn't just chop it off, chop it off, okay, and it's a way of thinking. I recommend this for people when their practices are booming. It's like you want to go through. Does this essential? Does this generate revenue? Okay, now I want to tell you three things to never cut off. Okay, these are three things we don't cut off because we need them.
Speaker 2:Number one advertising with a return on investment. Okay, so let's say you were running ads. You were running Google ads or Facebook ads and whatever. So let's say you're doing Google ads and from Google ads, you get 40 new patients every single month and you're spending a thousand dollars on it. Okay, now let's just make up numbers. Let's say you know, for their first visit their first visit is just for the sake of math let's say it's $150. Okay, so you have $150 times 40, right, that's $6,000. So you are making an ROI return investment of $6,000 for every $1,000 you spend. Okay, so how much do you spend on that, all the money you can spend, because it's paying for itself Every time you spend one, you get six, which is a net of five. You see what I'm saying. So, when we're reducing expenses, we don't cut that.
Speaker 2:Now, if you have the marketing team, you're paying 12 grand a month and they're not doing anything, by all means cut them Right. Well, when you have an established, documented I can see in the bank ROI you don't cut it off. You don't cut it off, okay. The second thing you don't cut off is coaching and consulting with an ROI, okay. So, for instance, in this conversation that I'm having, like, where we're troubleshooting this private practice, you will find that these strategies, if you execute them, the minimum you'll be able to get from this one conversation is a hundred thousand dollars, and this can extend to multiple seven figures depending on how aggressively you execute on these strategies. Seven figures depending on how aggressively you execute on these strategies, okay.
Speaker 2:Now if you are paying somebody right for this and you are getting the strategies that are keeping you in motion, you're getting the strategies that are helping you build, you don't cut that off. You don't cut that off right. You don't why the ROI is huge If you can go from a failing practice to a thriving practice, like a failing practice to a profitable practice, to a thriving practice through a coaching program. You don't cut it off, right, because the ROI is ginormous, okay. The third thing you're not going to cut off is you're not going to cut off your team with an ROI.
Speaker 2:So, let's say, your front desk person. You talk with them about this new strategy we're going to engage and this person takes her role as the director of finance like super seriously and she's collecting all the dollars and every day she's collecting between $500 and $1,000 in co-pays, old balances, all of these things. And you're like, oh, my payroll is so high, I'm going to slash my team. You don't slash that person because their ROI is ginormous. Do you see what I'm saying? Now notice for each of them. I said, with an ROI, if it doesn't have a return on investment, throw it away, but if it does, we don't cut that. Okay, all right.
Speaker 2:So your non-essential, non-revenue generating expenses, you can get rid of those. Okay, all right. So the next thing we're going to do for this really high overhead is to increase revenue. So we go back to what we had with number one. I'm going to talk about more. Right, we increase revenue. Right, because there's some expenses that just can't be cut. So we go after making revenue so that our expense to the ratio becomes a lot less. Okay, and this is my favorite strategy. My favorite strategy is let's create that. Of course, we want to shed fat and get rid of waste. We don't want to be wasteful. We want to be good stewards but at the same time, good stewards but at the same time, your revenue, this is your big strategy. Okay, all right.
Speaker 2:So then the doctor had team issues. So she said I have three team members no office manager, not there yet. Two are rock stars, one is not. Okay, I've had multiple conversations with this one with her productivity, but she doesn't know how to pivot. Okay, so she might be what we call a steady Eddie. Steady Eddies are people who will come, they will do the same thing every single day, forever. They're not going to be proactive, they're not going to come up with some big, daring, great plan and all those things, but they are steady Eddies. And so, right off the back, I will say, like, if this person is a steady Eddie, they do well in the confines of this one thing. When I say one thing, I don't mean one task, but I mean if you tell them what to do, they'll do it, but they're just not going to be creative and they're not going to do that. Then you want to ask yourself is this one I can repurpose? I'll talk about that in a second, so let me not get ahead of myself. Okay, so the team issues what's my recommendation? Okay, now I will start with my observations, and this is my observation after studying thousands of private practices over the years.
Speaker 2:Okay, the number one problem with most of the teams in private practices is the team leader. Is the physician owner, like we are the problem of our team. Right, and a lot of times that problem is because we don't define what their role is. We don't define what their role is, we don't define how this role makes money. We don't have clarity on what they're supposed to do. We have not communicated with them how to win, so they don't even know they're in a basketball game and they don't know where the basket is and, like we're the issue. Okay For the most part. So that's an observation I made. Another observation I made is that you know. So that's an observation I made. Another observation I made is that you know improperly led teams are where practice profits go to die Because you're seeing the patients, you're generating the revenue, but you haven't empowered your team, so your team becomes dead weight, your team becomes a liability, and so they're not creating revenue, so you are the only revenue generator, okay. So once you stop everything stopped, once you stop like you have no support, you feel like you're carrying everything yourself is too much, and I'm going to show you how to how to fix that and so. So that's where profits go to die, and we just didn't set up our teams to help us. To help us with the burden of ownership, with the burden of creating revenue, right, okay, burden of ownership with the burden of creating revenue, right, okay. So what are my recommendations as how to fix this? Number one define KRAs, key result areas for each role, and I didn't say key tasks, I said key result areas. So, for instance, for a front desk person, we're not saying well, greet the patients, check them in all of that stuff. Those are activities, those are tasks and those do nothing. Right, like, of course they're very important, but oh, my goodness, those are tasks as opposed to right, as opposed to, for instance, 100% collection on all co-pays, deductibles, co-insurance and old balances. Right, pays, deductibles, co-insurance and old balances, right. We say 100% insurance verification on all appointments, right. We say five Google reviews a day, which means they have to greet the patients in a certain way, do things in a certain way. So when the patient is leaving, it's like I hope you had a great experience. It would be so much to me if you could leave me a five-star review. That's how I keep my job. I'm not saying that's how she keeps her job, I'm just being funny. But when you have these outcomes, now their creativity is unlocked to go, make it possible and you can show them like. This is the outcome. These are the activities you do to get there. But when you do that, can you imagine you don't have to bear the weight of, oh, things were collected upfront, or we're getting reviews, or like, you're sharing, you're sharing it right, okay. So, and every role in the KRAs, every role, needs to include serving and earning. It has to include both. Okay, all right. So the second thing I would do is now distribute the outcomes linked with turning the ship around. So we've talked about a lot of things. We've talked about the billers. We've talked about collecting our old balances, maximizing daily production. We've talked about auditing. We've talked about all of these things. You want to do it with your team. Don't do it alone. Don't do it alone. So, for instance, we need to make sure we're collecting all the money for what we do. So the front desk person could have collected all the upfront money, right? You can have another person that's in charge of creating three appointments with this cash-based vertical that you want to do. Right, you have your biller with the metrics, so they're in charge of that. Like, share the burden for this stuff. Maybe you looked at your daily productivity and you're like, oh my goodness, like we're seeing four patients less than I actually want to see. They have another person who's in charge of making sure you see X number of patients a day. They're hitting the recaller, they're doing all the things. But do you see what I'm saying? Don't just bury it all. Bury it with the team. Cast vision with them. Tell them this is the kind of practice we're in. Tell them about all the private practices shutting down and we've decided we're not going to be a statistic but because we can do the things right, share it in such an inspiring way and tell them let's go. They will go with you, okay. Third recommendation repurpose or de-hire team members as needed, okay. So, like the study, eddie, if you need to repurpose them where they're doing something, where they're kind of doing the same thing, and it's a thing that needs to be done, doesn't need to be automated, and stuff like that, you know, like you kind of put them in that position. If they just can't work like they, hire them, and the sooner the better, okay. And again, this is one of the reasons why I like Practice Pilot. I think I'm going to keep mentioning it and you can check it out. It's practicepilotio. But this is one of the reasons I like Practice Pilot, because it's self-reporting and you don't want to enter the data. You want your team to enter the data, so they will see. Our goal was to see this number of patients, but today, oopsie, this is what we saw, right. And they're like, oh wait, we need to fix that. They're the ones who put in the AR. They're like, oh, my goodness, and they see that right, and the person and the insurance and all of those things. So you want that, because what it does is it helps your team see what you see and it helps them come to the conclusions you came to right. Okay, all right. So that was the fourth problem. That was the fourth problem she talked about. The fifth problem she talked about was her personal finances. Okay, so there's financial pressure there because she took out a HELOC, she took out from her 401k, she got a bank loan and she used this for renovations, equipment, furniture, personal bills, and she has personal bills still and stuff like that. Okay, so what is the recommendation here? Okay, now, first of all, I will say this If I was talking to this person face-to-face, I would say you want to be careful. If I was talking to this person face to face, I would say you want to be careful? Okay, because financial pressure is real. Financial pressure is hard and it is sometimes really, really hard to make smart financial decisions when the pressure shows up. Sometimes it's really hard. Money led decisions like I'm making this because of financial pressure are rarely ever the right ones, and I say this like I'm almost sending I'm sending virtual hugs first. I know this is hard and all of that stuff, but let's walk through some things to do. Okay, all right Now, and part of being careful is probably if you feel under so much pressure, you feel I must make a decision now. Now, I must do this now, now, now, now, now, probably decide to sleep over it when you're in that state. Don't make any decisions. Don't make any decisions, okay, so, so that's the first thing. Just be careful. Second thing aggregate all your debt, okay. So, these are all the things I owe. This is how much it is. This is what all the monthly payments come up to. This is what the total monthly payment comes up to. And talk to all your lenders. Everything is negotiable. Everything is negotiable. So if there could be a pause of something without increasing your interest rate, that would be awesome. If there could be a decreased interest rate, if they're willing to do that, that would be awesome. Talk with them. If they would do lower payments for X amount of period, again without changing the interest and changing the terms we don't want to go from one issue to another then that would be awesome. But don't make the assumption that it's not negotiable. Everything is negotiable. Everything is negotiable, okay. Number three I said this before, but I'm going to say it again prioritize services that increase cash flow. Okay, prioritize services that increase cash flow, because we want cash flow coming in. The thing that will give you the greatest peace, right with this, is bringing in revenue that makes up for that. Okay, all right. And one of the things was you know, do I sell my house or do I not sell my house? I would say it depends on you really want to think about that. For instance, if you're like I was looking to sell in the next one to two years anyway, and you had a home that has so much equity in it, it had a low interest rate, all of that stuff, and you'll be able to sell this, buy what it is you want now, and then you have profits off of that that you can put into whatever you want to. You can do that. If you're not thinking about selling it at all, and maybe you got a house in the last two years and all of that stuff and it's just going to be a lose, lose, lose, then you want to think maybe of not doing that. But what I will tell you is there are multiple loans here and you don't have multiple houses to sell, right? And so you kind of want to think of what would I do to get myself out of this, outside of the house, and then say, okay, do I want to go all in on doing that and then keep my house. You see what I'm saying. So there's a lot of thinking that needs to go into that. But I would say no hurry to do something that is fairly permanent off of something that is temporary. Does that make sense? So that's the way. But there's more, there's a lot more conversation. So I would say you want to be strategic with what you do here? Okay, but definitely talk to your lenders for sure, for sure and for sure. Get that cashflow engine going, bringing revenue in and all of those things. Okay. So lots of stuff. And so this is the last one and it's mental exhaustion from all of this. Okay, and I'm going to read what this doctor said. I think it's important because this is what she says. I'm a solo doc. I've always done it alone. I haven't had mentors or physician colleagues to bounce ideas off. I feel isolated. I'm a black female physician in town with only two to four other black females in private practice, but there are 30 to 40 doctors in my specialty in this town and all that stuff. I'm losing hope. Okay. So again, first of all, specialty in this town and all that stuff. I'm losing hope, okay. So again. First of all, long. You know the long squishy hug like long, squishy, big, understanding hug and all of that. And I do want to say, you know, thank you so much for what you do, because you've chosen to serve people for this long. You've chosen to build your own healthcare system, which is really what we do as private practice owners, and think of what thousands of people who would not have access to great care if you didn't say yes to doing what you do. So big, big, big hug. And I want to say the principles of rest. Sometimes it's really hard with what you're going through, but there's rest, there's meditation, but there's also a support system and I want you to understand that, no matter what it's out there, you can have a support system. It may look different, you may need to get a little creative right. Some of them may be outside of your area and some of them may not even be close to you. They may be online. I have such great relationships with some doctors who've poured into me so much and who I've been able to bounce ideas off and all of that, and I haven't even met them in person. Some of them I met them in person after three years. You know what I'm saying and so I don't want you to accept this, the fact that you can't have a great support system. I want you to know that you deserve a great support system and then build it. They may not all be in your area, they may not all be like you, they may be online and all of that stuff Just refuse to walk alone, right? And so what is a good starting point? In the communities where you do find yourself, show up, ask questions, talk to people, schedule lunch dates, schedule Zoom meets, zoom meet and greets, have conversations, start networking and you find your people, or people who know your people, and all of that stuff. Right, I will start, but I will start from this thing that of course my support system is out there and of course I deserve a great support system. And no, I am no longer going to walk alone. I'm just not going to do it right and know I am no longer going to walk alone, like I'm just not going to do it right. And so, whether there's spaces online, you know, if we have a number of communities, we have the Profitable Private Practice Movement, like if you're part of that, like when you come in there, show up, show up in the comments, connect with people and then take those relationships offline and stuff like that. Like, do that. The Entre Ambi Business School is another one, huge relationships offline and stuff like that. Do that. The EntreMD Business School is another one, huge, huge, huge one. Right, and build your own community. And in a time where most people talk about private practice being dead and you can survive and woe is us and all of those things find people who are saying the opposite. Find people who, like you, want to take their practices from not doing really well to really really profitable, to thriving. Right. So do that, right. So show up in those spaces and start building those relationships. Okay, set a target for yourself three, then six, then 12, then whatever and build that for yourself, okay. And then you know so good, well, it always comes back. You know what I mean. And so when you have an opportunity to help somebody and when I say help, I don't want to mean like you shut down your office for a day and go do stuff. I'm not even talking about that. I'm talking about simple things like somebody opened a new practice and you're mailing them a card and saying, oh my goodness, congratulations, welcome to the area. Somebody gets an award. You like, congratulate them Somebody. It seems like they're struggling, you encourage them and stuff. It's goodwill, and the thing about goodwill is it's going to come back to you. It may not come back from the person you showed goodwill towards, but it will come back from somebody, right? And so do that. Do it knowing that I'm just sowing these seeds and they're going to come back to me, but refuse to walk alone. And if you look in your circle, your network, your area, you'll find that there are people I can show goodwill into and there are people that I can start having conversations with and start building that support system, right, whether they're online or they're in person and stuff like that. And so I know we went through a lot of stuff, but I hope out of this you can build out like this is where I'm going to start from and revenue you really want to to start, you want to really want to start with fixing the revenue and all of those things. But you have things that you can say okay, these are the seven strategic things I'm going to do over the next 30 days with my team. So, with your team, you can do seven right, like I'm going to do over the next 30 days to put my practice in a position where we can start the process of thriving right. And these are the things you can map out. And if you have questions, you know for everyone who's watching the comments and all of those things like post them in the comments. I will come back. I may make a whole video on all of those things, but for this doctor, I want you to know that I am rooting for you. I believe in you. Obviously I support you. I that I am rooting for you. I believe in you. Obviously I support you. I guess I'm one of your supporters, right? I support you and I really cannot wait to hear about you turning this around. I know that, yes, it's going to be challenging. It may even get a little harder before it gets easier, but I know you can do it and I know you have the strategy and I'm rooting for you. Stay connected to us, whether you're in PPPM or you're reading the Profitable Private Practice Playbook, and we have so many resources. If you have questions, just post them in the comments. I'll come back for it. Okay, now I want to challenge everyone to take the link of this video watcher. If you're listening on the podcast, I want you to take the link and share it with every private practice owner you need, because these are strategies that work, whether your practice is struggling, or your practice is profitable, or your practice is thriving right Like these are the things we want to stay on top of. So we continue to thrive, because the more we thrive, the better it is for our patients, the more empowered physicians we have, and then we now have a group of people who can go into the healthcare system and turn everything right side up. Okay, all right. So absolutely rooting for you and I'll see you on the next episode.