11/14/2022
Do you have the mindset needed to be a physician and an entrepreneur?
We need more physicians to enter the entrepreneurial world and impact the future of healthcare. Physicians are uniquely positioned to understand the problems and are often inspired to seek solutions rather than settling for workarounds. Of course, this work is hard and is not something routinely taught in medical school or aligned with a physician or our clinical practice mindset.
You have a great idea, but are you willing to enter the entrepreneurial world? If yes, than you will face a set of unique challenges that you may not be ready for or aware. The entrepreneurial mindset can be achieved by physicians but first they must recognize this road will require “different” thinking.
My advice for physicians, before you begin, first examine if you can think like a physician and an entrepreneur? Can you shift to a mindset where you truly can embrace what it will take to push success both clinically and financially? Can you embrace the balance of margin and mission? Or are you thinking that everyone should just support your idea because its best for the “patient” or because it is physician led? Can you recognize the value add of the business mindset? Or is the mention of business or revenue something you find appalling?
If you think you can move to this “physicianpreneur” mindset, here are a few key learnings that I have taken from the school of hard knocks. The first step is recognizing what brought you to this idea from a clinical mindset will be very unlikely as to what you need to makes your idea successful as a business. Ponder these thoughts around your current and newly needed mindset:
On business success:
· As physician: Can you recognize that running a successful practice is very different from running a successful business. Yes, it is true. Our healthcare system is a key driver of your practice success. The system is set up to send you patients, often mandate they receive care, and bill someone else to pay for your service. We physicians also get paid for the service we provide even the patient leaves unhappy or doesn’t get better. To drive practice revenue, the model is to see more patients, run more tests and see them as fast as you can. The practice’s businesses rate limiting step is scaling as you will be limited by how many patients you can squeeze in and how much staff you can hire until you must begin to deny patients, stretch out wait times etc….
· As an entrepreneur: As you will quickly learn, your startup “business” will apply very few of these factors. The success of your business will rely on whether your product succeeds or fails to influence your customers behavior. You will not only need a great product, but you will also need to create demand for your offering. How will you build your product? How will potential customers know your product exists? How will you acquire customers? Will customers buy your product? How much will they pay? Will they stay and even better refer others? Is it scalable and if so how fast? A huge change in mindset will be how you measure your success. The top measure of your success and/or failure will be measured through a financial spreadsheet.
On managing costs:
· As a physician: If you are an independent practice owner, you may currently have to consider how to manage your overhead in your practice. You will have to decide how many staff, what ratio, should I add or can I get by with less? Can I drive more revenue by adding more staff? You will have to manage costs of supplies and medications. If you are an employed physician, by others or in an independent practice, you likely currently have none of these worries. The hospital or your practice meets all your needs and should help you drive more “revenue” simply by helping you at any cost to see more patients. They will seek ways to make you more productive. The main focus is how you can see more patients and how to get your billings out more correctly and quickly so as to get paid. The practice pain point is prior authorizations, poor contracts and delayed payments by insurers and patients.
· As an entrepreneur: You will have to manage costs from day one. You will need to recognize that adding more costs won’t drive you more revenue necessarily. You will also need to invest in building a product before you start. These costs may be substantial and will be needed to be spent long before you see any revenue. You will have to decide what balance of spending drives more customers while not draining your cash on hand. Don’t forget, no one is driving your customers to you. You will have to think about how you not only develop your idea but market it and acquire customers. How will you do this? How much will it cost? Will it be effective? Marketing is a new budget item and often not in your initial financial forecast.
How you control your time and growth:
· As a physician: You grow your practice in response to growing demand, higher revenue, or by adding more ancillary staff. You can control your hours largely and decide if/when you are available. Vacation is on your terms. You can even have others cover your business while you are away. You can close early, stay late or decide that patients going elsewhere after hours or on weekends is no big deal since your weekly schedule is full. If you schedule is full, you don’t see a need to see if your patients are going elsewhere or have left you for another offering.
· As an entrepreneur: You only grow your business by working on your business and ensuring you have the team around you to meet demand while not exhausting valuable resources. You will need to be on 24/7/365, know every aspect of the business and be able to respond or pivot as the business demands. You will need to monitor revenue, expense, cash burn and oversee all operations. If you gain investors, you will be reporting to them and responding to them on the outcomes of the business. Outcomes that will be measured on your spreadsheets, customer retention and promoter scores and not quality metrics. You will no longer be paid for what you think is good work or trying to deliver care, you now are paid and recognized solely on key performance outcomes. A business is never full and always seeks to continue to grow and expand.
How you are perceived professionally:
· As a physician: You take great pride in your clinical care and appreciate your colleague’s perception that you are offering great care to everyone. As a physician you know that cost to the patient or the insurer doesn’t play into your clinical thinking. You want your perception to be all about quality and knowing your guiding principle is what’s best for the patients. You of course see other entrepreneurs as owners, vendors, salespeople, or the insurance “suits” that are trying to run your business or profit from you.
· As an entrepreneur: You will most likely be seen like all other vendors and salespeople by your colleagues. Your colleagues will not see as the physician you once were but rather as someone more aligned with driving financials and focusing only on margin. Physician colleagues will be unlikely to see you as someone trying to solve a problem or improve care. They also may not choose your product despite it being a better fix than the workaround solution that is cheaper. Entrepreneurs need thick skin as your professional perception may change.
Overall, the greatest challenge we have in healthcare is recognizing that we need multiple perspectives, risk taking and great solutions that come from those closest to the problem to succeed. Physicians can and should play a key role and can be amazing entrepreneurs. However, we and our colleagues need a mindset that differs from our current physician thinking and will need to embrace that both mission and margin are needed to achieve success. A combined mindset will help us understand how to better partner and merge our clinical and business minds to drive the outcomes we want to see. Physicians can and should lead this success, should support other physicians and recognize the value of physician entrepreneurs. Physicians should not shy away from partnering with great business minds or feel they need an MBA to become an entrepreneur. Physician led businesses who add great business minds will be for more successful in my opinion and will achieve greater outcomes. Mission and margin will drive better care because physicians can lead to better solutions and not just apply band aids. Who should better to understand and lead this balance other than a physician?
Note: Welcome to the first newsletter of “What the doctor sees”.. this newsletter is based on the opinion and experience of this physician and is intended to foster dialogue, discussion and debate. The opinions expressed here are not medical advice, sometimes will have references but for the most part will come from experience. Please add yours to the discussion whether they agree or differ. We can make healthcare better together and through sharing of great ideas.