The EntreMD Podcast

5 Warning Signs You Are NOT Ready to Hire a Physician in Your Private Practice

• Dr. Una • Episode 500

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How do you know you're ready to hire a new physician in your private practice? 

This is a question that I am asked a lot, and it is so important to answer, because when it is done wrong, it can create unbelievable stress, strain, and chaos in what was once a very calm and successful private practice. So, before you make that potentially detrimental hire, ask yourself whether your practice is really ready for that kind of growth. 

In this episode, I’m walking you through the five critical warning signs that tell you it’s not the right time to expand and explaining how to set yourself up for success in the future. 

Tune in! 

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Key Takeaways: 

  • 00:00 Intro
  • 03:47 Your schedule is not full
  • 05:16 Your cash flow is inconsistent
  • 07:10 You don’t have a predictable patient acquisition system
  • 11:33 You don’t know your numbers
  • 13:20 You haven't embraced your role as a leader
  • 16:07 Project-based approach to practice improvement
  • 19:32 Outro

Additional Resources:


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SPEAKER_01:

Am I saying you're not ready because something's wrong with your practice? No, because I don't want you to bring a doctor into your office and go completely upside down. Doesn't matter whether you're just starting or you're a multi-seven-finger practice because if you don't have the foundation, you don't have the foundation. And this is why multiple seven-finger practices go out of business.

SPEAKER_00:

Hi dogs. Welcome to the Untream D 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.

SPEAKER_01:

How do you know you're ready to hire a new physician in your private practice? All right. This is a question that I get asked a lot. And this is a question that is so important to answer because when this is done wrong, it can create unbelievable stress and strain and chaos in what was once a very calm and successful private practice. So today I'm going to show you five signs you're not ready to hire another doctor. Okay. All right. So I have been in private practice for the last 15 years. I have hired doctors like from my second year in private practice. And I've had to look at when is the right time to hire, when is not the right time to hire. How do I do this in such a way that my cash flow doesn't get upside down and all of those things? And so I guess I can say that I'm taking 15 years of wisdom and study and putting it, condensed it into this episode. But really, what I want to show you here is five signs you're not ready. Five signs you need to put some other things in order before you do that. And you may say, Dr. Una, but you don't get it. I'm really burned out. My schedule is full. I'm so stressed out. The solution here is to hire another doctor. And you may be right, but you may not be ready. There may be some things that need to go in place before you do that. And you might say, Well, I'm just going to do it anyway. And so I want to put a caution here and tell you why this is so important. I have met a lot of doctors who have had private practices. Maybe it was just them and they were doing well. Okay. So they had come to this place, like, oh my goodness, you know, I left my employed physician, my employed physician. I didn't know I could start a private practice. I started this private practice, and here we are, you know, we're we're bringing in, you know, good money, we're taking care of a ton of patients, we're doing all of these things, and we just want to get this good thing to keep going. So we're going to add another doctor. And they did not look at what I'm telling you about now. And they went from that to a practice where they started having financial pressure. We're talking the lead doctor had to go get a locum job to pay the to meet the payroll for the team that they they already had. And because that was upside down, the patient experience started going upside down. Team members started sensing that there may be some financial stuff going on here. They started looking for greener pastures. And the doctor, the owner, had so much burnout and so much fatigue that they were ready to throw the whole thing away. Okay. And all the profit they had completely disappeared. Let's talk about it. Okay. How do you know? And does that mean if you're not ready, you can never hire? No, it just means, like, you know, you flip what this is and you turn that into a project and you fix those things and you're ready to go. It's kind of the, you know, like if you were going to sell your home, chances are you're going to do some repairs here and there because it will increase the value of your home and you're going to touch up paint here and those kind of things. Just kind of rehab the place, if you will. This is giving you direction for rehabbing your practice. Okay. And if you're watching this and you're like, wow, I hired somebody, maybe I shouldn't have. It was too early or whatever. You can still tell now by based on what we talk about, what is wrong. So you can go fix those things and then it'll be okay. All right. So Dr. Luna is here. I'm on your side. Okay. So five signs you're not ready. Number one, your schedule is not full. Okay. I cannot tell you how many times I meet somebody, their schedule is at 50% or 60% of capacity, but they decide as a physician owner, I'm tired, so I'm going to get another physician. Okay. But if your schedule is not full, chances are like your practice may not be profitable or it's marginally profitable. Right. And when I say your schedule is not full, this could be you as a solo doc. This could be as a doc with six docs already looking to bring on a seventh, but your six docs are not at capacity, right? And so which means your overhead to your profit margin is slimmer than it needs to be. And when you have five doctors, that's even more risk, right? Because if if five doctors' schedules drop, that is even more risk. And then you bring on another. Like that's just asking for trouble, right? Okay, so your schedule's not full. And if your schedule is not full, I would typically say fill it up. Fill it up and then hire. And now, of course, when you're at 80% or you know, 90%, you can, you know, you can start looking, you're doing all of those things, but you're very clear on when this person is coming on board. You know, it would take you a minute, right? Like so you you can by the time you're at 100, you have the person you need, and you can start looking if the other things are in place, then you can start getting that person on board. But if your schedule is not full, do you need to hire another doctor? Maybe, but not just yet. Fill the schedule first. Yeah, fill the schedule first. Okay, so that's the first thing. Okay, that's the first thing is fill up your schedule. The second sign that you're not ready is that your cash flow is inconsistent. Okay, your cash flow is inconsistent. And a lot of times this can be traced to what is happening with your billing department. Part of it could be number one, which is that your schedule is not full. You know, some days you have 50% capacity, some other times you have 70% capacity. So it's kind of like we we're seeing what's coming, like we'll see what comes, which is not good to add another multiple six-figure thing to your payroll when you're not sure about that, right? But when I talk about your cash flow being inconsistent, one of the things I'm referring to is your billing department. And so it could be that you have a billing department that is inconsistent. So they do their job, you know, when they want to do their job, and if they went away on a conference, then everything stops. Or if they have financial pressure, their personal financial pressure, they work your stuff and when they don't, they don't, right? So it could be something, it could be something like that. So you just have the wrong company, or maybe your billing is in-house and you have an improperly led biller. You know, the billing happens sometimes, billing doesn't happen all the time. Or you may have an office manager who runs your office and it's a very busy office and also does your billing. And so it's an item on the to-do list. It's not somebody's sole responsibility. And so it gets done sometimes and it doesn't get done sometimes. So you have this big swing, and you can have the same number of patients, but you're getting paid like ginormously different amounts of money and stuff like that. And when you can predict, again, adding multiple six figures to your payroll expense, if you will. You know, we we call it an investment if you're doing it right. And so if you bring in another doc, what you're doing is you're multiplying chaos. You're better off figuring out like how can we get a handle on what's happening with our billing and fix that and then take it from there, right? Okay, so that's the second thing I would look at. That's the second sign. The third sign is that you don't have a predictable patient acquisition system. And I'll explain what I mean by that. When I talk about a predictable patient acquisition system, what I'm referring to is whatever engine you've put in place to control the way you want your schedule to look. So during COVID, one of the common things I heard people say is my phones are not ringing. People are not calling to schedule appointments. I'm like, your phone is not there to ring. Your phone is there for either people to call you or you to call them and make appointments happen. If they're not calling you, you call them. The phone didn't go away. You know what I mean? And so is this whole concept of being able to proactively fill your schedule, for you to look, you know, two months out, a month out, a week out, a day out and say, huh, what's going on with our schedule here? And you know exactly what to do to fill it up. Now, some of them will be long-term strategies, some of them will be short-term strategies. For instance, your strategy could be, you know, we work our referral sources, we show up on social media, we email our patients, we ask our patients to send us more patients and we ask for reviews, we run ads. You may have these, you know, three, five, seven activities that is kind of like a formula for filling up your schedule. And you've worked this and you've tested it and you've experimented with it, and it works. You know what to do to fill your schedule. The reason why that is important is one, because you can fill up your schedules and your doc schedules, the doctors you have now. And then when you bring somebody else in, you know what to do to fill their schedule. You're not saying I brought them in, I was hoping the phone would ring. I was hoping people will make appointments online. You know what to do. So if you don't have that, then you kind of want to work on that. Okay. One of the things we're we've done is that, you know, we've created a number of resources for private practice owners because we want to see private practice owners win. So for instance, one of the resources we have is the Profitable Private Practice Playbook, and which is a book where we're like, if you read the book and do the book, your practice will be profitable. Like, really, we just put, you know, over the last 15 years, the best stuff that I had. I'm like, what can I put in a book that if they can just follow the book, they can win, right? Now we all know that in addition, we know a lot of things that we're not doing. Okay. And I said, okay, what is something that every private practice owner can have that would help them implement these things? And that is the profitable private practice movement. So it's on trimd.com forward slash movement, where we get together every Thursday to work on our practices, right? We know this concept of working in your business versus working on your business. This is what we do to work on our businesses, to work on our private practices. And so one of the things we teach there is the seven-figure marketing system, the seven-figure referral system. So you can build that system and start testing it for your practice. Now, when we do these things, what is the number one thing that leads to patient visits? Number two, number three, right? And so you can put the right amount of energy and money and team behind that to continue to create those results. And you know, when we do this in this combination, this is what our schedule looks like, right? And so if you're not part of the movement, this is the best$197 you can spend in your practice like ever, right? Because you get world-class strategy and no, there's no fluff. We we really focus on three things. How do you fill your schedule? How do you get paid for the work you do? How do you build a profitable team? Knowing that if you have these three things, chances are you're working on the all the concepts in this book. And if you do it, your practice will work. Now, you may want to take you to the next level. We have all kinds of different programs for different things, but this doesn't matter whether you're just starting or you're a multi-seven-figure practice, because if you don't have the foundation, you don't have the foundation. And this is why multiple seven-figure practices go out of business, right? So if you're not a part of it, if you're like, I don't have a predictable patient acquisition system, this can be a historical fact. All you have to do is is join the movement. So on trademd.com forward slash movement. Okay. So that's the third sign. You don't have that. That's the third sign that you're not ready. Okay. Now I'm saying you're not ready because something's wrong with their practice. No, because I don't want you to bring a doctor into your office and go completely upside down. Okay. All right. Number four, you don't know your numbers. You don't know your numbers. I hope nobody perceives this as I'm judging you. Like, I'm not, because I've done many of these things, right? Like at a point, I did all of these things. Okay. I know what it's like to look at, you know, what is revenue per patient visit? What's your, you know, your patient volume, what's your break-even point, what's your profit and loss? Oh, and I'm like, Rrrr. I literally, okay. So my husband is an accountant by training, right? In the earlier years of my practice, and when I say earlier, I mean like the first six or seven years. I'm not even saying, I'm not even saying like early, like the first year. When it would be time to meet with the accountant, go over numbers and all of that stuff. Do you know what I did? I would tell my husband, like, this sounds like a you problem. Like, you could have a meeting with the I see the patients, I run the operations, and I have babies. Okay. I birth four babies. You can meet with the accountant. I'm not gonna do that. And literally, I would skip the meeting. I get that. But you see, as entrepreneurs, we have to understand the money. We don't have to like it. I'm not like crazy, like, ooh, let's go look at numbers. Like, I'm not crazy about it, but I have to look at it. And so I look at it. And I look at it as often as I need to look at it, right? To make the right decisions and to know what exactly is going on and put my, you know, my practice and my other businesses in the best position to thrive. Okay. So I have to know the numbers. At baseline, right? What is our revenue per patient visit, right? For insurance-based practices? What is our volume? What is our break-even point? Like, how many patients would my dog need to see to cover their salary? Maybe cover their overhead, maybe cover, you see what I'm saying? Like when they see this number of patients, what does that mean for salary, overhead, and profit for the practice? Like, we have to know these numbers. Okay. And if you don't know them, you can know them. That's the point. You can know them. Okay, number five. Number five, the fifth sign you're not ready is you haven't embraced the role of a leader. Now, this one, this one right here is huge. And because a lot of physicians start here where, yes, I own a practice. Yes, I have team members. No, I will not meet with them. No, I will not hold them accountable. No, I'll not de-hire them if I need to. No, I'm not going to give them feedback. I'm not going to do any of that. I'm just going to pay their payroll and hope they do good work. A lot of times that's where we start from. Now we may have gotten to the point where, like, oh, we can lead like our MAs and our front desk and all of that, but we're not talking to the office manager. We're definitely not talking to the doctors. And your practice needs a leader who will lead everybody. Your practice needs a leader that will lead the entire team. If you're going to bring a doctor on and you're going to enjoy that relationship, you are going to need to lead them. You're going to need to lead them, right? And so what that means is, you know, you want to embrace the role of a leader, which means you're going to define these are the outcomes that this doctor is responsible for. When you interview them, you're going to tell them these are the outcomes you're responsible for. When it's time to onboard them, you are not going to shy away from it and say, oh, the doctor knows everything. Like they know a lot of things, but they don't know your company. You're going to onboard them. Which also means, like, when it is time to give them the gift of accountability and to give them feedback, you're going to do that. Like you're going to do that. You want to embrace that. You want to own that so you can lead your doctors. And leading is not micromanaging, right? Every great organization needs a leader. And the leaders need a strong leader. And you may think you're like, that's it. I just don't need to hire because I'm not a strong leader. No, leadership is a skill. You can develop it. You can develop it. You've done so many things. You've replaced hearts. You've memorized the Krebs cycle. You started a business. You got it profitable. You're doing all of these things. Of course, you can lead others. You can lead physicians. You can lead office managers. You can lead all these people, right? But it's a skill. You learn it. You learn to delegate. You learn to hold accountable. You learn to give the gift of accountability. You learn to do all of those things. I started off as a super shy, socially awkward introvert who was phlegmatic at her core, which meant that I would do anything to avoid conflict. Do you see how this is not a winning recipe for entrepreneurship? When you say that you want a profitable, thriving, seven-figure, multiple seven-figure practice, what you're also saying is I'm going to be a great entrepreneur. I'm going to be a great leader. I'm good. Like that's what you're saying. You're saying yes to these things. You're saying yes to leading a team. And you can learn it. If I could learn it, you can learn it. And I'm not saying that to be cute or to make you feel better, but it's the truth. I know where it started from. So let's look at this. What are the signs? Let's go over the signs real quick. Okay. Your schedule is not full. And the reason why I want us to go over this again is because I want you to think about it. There's nothing we've talked about here that is a problem. It's not a problem, it's a project. It's not a problem. It's a project. So my schedule is not full. Means I'm not ready right this moment to hire. But it does mean I have a project. I need to fill up my schedule. I need to figure out how to do that. I need help actually I'm coming to the profitable private practice movement with Dr. Una so I can start working on that. Okay? All right. Cash flow is inconsistent. Maybe you've never met with your biller. Maybe they just send you random reports and tell you everything is good. And because there's enough money in the bank to meet payroll, you don't even bother about it. Now you start meeting with the biller. Maybe you start learning what those numbers mean. You start learning what are the five metrics I should track every month and all of those things. And then start that process and start paying attention to your cash flow. See, you we don't idolize money, we don't worship money, we don't say money is the number one thing. We don't do any of those. But as an entrepreneur, you are required to respect money. We don't just like, oh, I don't talk, I don't do anything with the money. No, we don't we don't get to do that. Okay. We have to respect the money. So we pay attention to where it is, where it's flowing to, is it flowing in the right amounts, all those things. Okay. Okay. Number three. So we again just make it a project. Number three, we don't have a predictable patient acquisition system. Okay. And you're like, okay, I don't have a predictable system. I just take whoever comes. I think we're just going by word of mouth and all of those things. Great. Now we're gonna flip it and we're going to make this a system. So when our schedules are not full, we know what to dial up to fill it up. When we bring on a new doctor, we know what to dial up to fill it up. Number four, you don't know your numbers. You don't know your numbers. Again, this is just a project. What numbers do I need to know? Let me go start knowing them. Okay, revenue per visit, my patient followings. Well, that looks like my break-even point. Take a look at my profit and loss state and start looking at those things, start knowing my numbers. Okay. Again, it's a project, it's not a problem. There's no problem. We have not discussed a single problem on this episode. Number five, you haven't embraced the role of a leader. And then you're like, okay, I have a project. I'm going to embrace the role of a leader. Notice I did not say you have not become a perfect leader or you have not become the greatest of the great leaders, right? You start that process. So what does that mean? I never meet with my team. Now it's time to meet my team. I need to start casting vision. I've never held my team accountable. It's now time to meet them accountable. I have never given them metrics that this is how you know you're doing a good job. Now it's time for me to do that. Again, these are all things that we do in the profitable private practice movement. So if you're like, I don't even know where to start, I will tell you exercise on training.com forward slash movement. Start, come join us. Okay. So these are the things that you look at. And you can start with a simple 90-day project and you're like, you know what? I'm going to do these things, whichever ones are missing. I'm going to work on these for the next 90 days and put us in the best possible position to start bringing a doctor on, especially if you're burned out, you're tired. I just need another doctor and all. Let's get this stuff taken care of. And the truth of the matter is as you take care of this, you will feel less burnout. You'll feel much happier. You'll be in a much better state to bring this doctor on. And then you can put out that ad and start getting ready to bring a doc on. But please, please, please, please, please get yourself in the best position to bring a doc in, to get their schedule full, to get ready. And because when you do it that way, you can get your doctor busier faster. You can protect your cash flow as you bring the doctor in. And then you can create more cash flow as they do what they need to do. So I'm rooting for you, rooting for you, like unbelievably, because of course you can do this. So many people have, and you can do it too. If you need support from my team and for like, how can you guys work with me to help me pull this off on traind.com forward slash call? We'll be happy to walk you through everything we do. And of course, we do not do high pressure sales or anything like that. Okay. So create your project. And this is really the picture I want you to hold. I want you to hold this picture of your schedule being full, of cash flow being good, of you leading your team, of you understanding your numbers, of you having a system that creates patience, like you know how to control your schedule. Like just imagine that. And then you bring a new doctor into this match. Just think about that. So I want to hold that picture as you do this work, this 90 day project to get your practice where you want it to be. Okay. Don't believe the lies, you can't do this. Of course, you can.