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Practice management

2,086 articles · Since 2017

Articles, page 2

Physician finance

The sweet spot before physician financial independence

Many physicians believe they can't escape burnout or an unsustainable career until they've become financially independent. Thankfully, it's not true. The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners,…

Many physicians believe they can’t escape burnout or an unsustainable career until they’ve become financially independent. Thankfully, it’s not true.

The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners, financial independence is a mathematical problem to solve. I might be able to run your numbers in a Monte Carlo analysis and demonstrate you have, say, an 84 percent chance of …

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The sweet spot before physician financial independence

Physician finance

Negotiating physician compensation works better in groups

Most physicians who have ever asked for a raise or tried negotiating their compensation have likely heard some version of the same sentence: "We have a standard package for the whole department. I can't make an exception for you." Most…

Most physicians who have ever asked for a raise or tried negotiating their compensation have likely heard some version of the same sentence: “We have a standard package for the whole department. I can’t make an exception for you.”

Most doctors hear that as a brush-off. It isn’t. It’s the most honest thing an administrator will say to you all year.

They genuinely can’t do it. A one-off adjustment creates a parity …

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Negotiating physician compensation works better in groups

Physician finance

How doctors lose money investing: 6 failure modes

I have been pitched investments in a doctors' lounge, at a conference dinner, and twice in a specialty group chat. Every one of them came from another physician. That is not bad luck. That is the design. This piece is…

I have been pitched investments in a doctors’ lounge, at a conference dinner, and twice in a specialty group chat. Every one of them came from another physician. That is not bad luck. That is the design.

This piece is about the specific ways physician money gets lost, and what actually works against each one. Not general advice about saving more. Named failure modes, with the fix for each. I have …

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How doctors lose money investing: 6 failure modes

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Hiring medical office staff who actually follow through

There are two types of employees: the go-getters and the gunnas. The go-getters are those who have a clear vision of setting out to do something, giving it their all, and accomplishing it. They don't need to be monitored. They…

There are two types of employees: the go-getters and the gunnas. The go-getters are those who have a clear vision of setting out to do something, giving it their all, and accomplishing it. They don’t need to be monitored. They are the first to arrive for a meeting or at work and the last to leave at the end of the day. They are self-starters and serve as role models …

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Hiring medical office staff who actually follow through

Physician finance

Credit balances in medical practices have a deadline

Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in…

Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in the practice management system as a negative number on a patient or payer account, it rarely triggers an alert, and it quietly inflates the bank balance the owner looks at …

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Credit balances in medical practices have a deadline

The Podcast by KevinMD

Why weak branding is costing private practices patients and talent [PODCAST]

Patients now choose doctors the way they shop for everything else, judging your practice online before they walk in. Ashley Gay, a branding expert, argues that a strong brand is not about ego but about earning trust, and that physicians…

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Patients now choose doctors the way they shop for everything else, judging your practice online before they walk in. Ashley Gay, a branding expert, argues that a strong brand is not about ego but about earning trust, and that physicians who ignore this are quietly losing patients and talent to competitors …

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Why weak branding is costing private practices patients and talent [PODCAST]

Physician voices

A national medical license would cut administrative burden

Lawyers have to know the laws of the state where they practice. Physicians largely do not. Medical norms, ethics, and morals are close to universal, which means physician practice could in principle be governed by universal law. There are exceptions.…

Lawyers have to know the laws of the state where they practice. Physicians largely do not. Medical norms, ethics, and morals are close to universal, which means physician practice could in principle be governed by universal law. There are exceptions. Contraception is one, where even clinical practice is governed by state-specific law.

The broader pattern is stranger than the exceptions. Neither lawyers nor physicians should have to acclimatize to institutional norms …

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A national medical license would cut administrative burden

Physician finance

Physician autonomy predicts who leaves, not exhaustion

A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not…

A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not describing a job. He was describing a sentence he had to serve.

That word, trapped, comes up more than exhaustion does.

This piece is about that feeling and what the evidence actually …

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Physician autonomy predicts who leaves, not exhaustion

Physician finance

Patient balance collection is nobody’s actual job

A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient's face changes. The staffer wasn't hired for this conversation and doesn't have…

A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient’s face changes. The staffer wasn’t hired for this conversation and doesn’t have much beyond “that’s what the system says you owe.”

This exact scene runs in practices everywhere, multiple times a day, and almost nobody standing at that desk was ever specifically trained …

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Patient balance collection is nobody’s actual job

Physician finance

Student loans are not blocking your practice ownership

Clinicians are trained to demand certainty before they act. In the operatory or the exam room, that risk-averse instinct is exactly what keeps patients safe. Applied to career decisions, the same instinct becomes one of the most expensive habits in…

Clinicians are trained to demand certainty before they act. In the operatory or the exam room, that risk-averse instinct is exactly what keeps patients safe. Applied to career decisions, the same instinct becomes one of the most expensive habits in modern health care.

There is a sentence I hear almost every week from young clinicians, and it sounds so responsible that nobody ever questions it: “I’ll think about ownership once my …

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Student loans are not blocking your practice ownership

Physician finance

How to run private fund due diligence like a reviewer

I have reviewed manuscripts for more than thirty journals. The habit is always the same. Skip the abstract. Go straight to the methods, because that is where the paper either holds up or falls apart. Then a fund pitch lands…

I have reviewed manuscripts for more than thirty journals. The habit is always the same. Skip the abstract. Go straight to the methods, because that is where the paper either holds up or falls apart.

Then a fund pitch lands in your inbox and the habit disappears. The deck opens with a big number, and most of us read that number the way we would never read an abstract.

First, the words, …

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How to run private fund due diligence like a reviewer

Physician voices

The certification process that has no off-ramp

For those of you navigating the American Board of Internal Medicine's (ABIM) Maintenance of Certification, I thought this anecdote might shed some additional light on the problems with the process. On June 26, I had a two-level spinal fusion. On…

For those of you navigating the American Board of Internal Medicine’s (ABIM) Maintenance of Certification, I thought this anecdote might shed some additional light on the problems with the process.

On June 26, I had a two-level spinal fusion. On May 9, I called the board to see if it was possible to “stop the clock” on the questions, since I anticipated, correctly in retrospect, that I would not be in …

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The certification process that has no off-ramp

Physician finance

Prior authorization appeals stopped being a decision

The letter says denied. It's not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there's…

The letter says denied. It’s not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there’s no real reason to think this one would be different.

Nothing about that moment is really a decision anymore. It stopped being one a while back, and nobody noticed exactly when.

The …

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Prior authorization appeals stopped being a decision

Physician finance

The revenue gap a physician notice period never closes

A resignation letter arrives with ninety days written on it. Most practices read that as ninety days to find a replacement, and the search starts that afternoon. What the letter actually started is three clocks running at once, and only…

A resignation letter arrives with ninety days written on it. Most practices read that as ninety days to find a replacement, and the search starts that afternoon. What the letter actually started is three clocks running at once, and only one of them speeds up when the practice hires faster. The payer contracts have their own notice terms. The medical records have their own custody obligations. And the replacement physician, …

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The revenue gap a physician notice period never closes

Physician finance

Retirement account taxes distort physician net worth

Your net worth statement is the only financial document in America that routinely counts someone else's money as yours. It lists the retirement accounts, the brokerage, the house, the practice interest, and adds them with the quiet confidence of arithmetic.…

Your net worth statement is the only financial document in America that routinely counts someone else’s money as yours.

It lists the retirement accounts, the brokerage, the house, the practice interest, and adds them with the quiet confidence of arithmetic. The number is not wrong so much as incomplete. It books your assets at gross, and the largest have a co-owner who has not yet invoiced you. A $5 million pre-tax …

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Retirement account taxes distort physician net worth

Physician finance

How to run a drill on your physician succession plan

In 2009, a New England Journal of Medicine analysis examined 84,730 patients undergoing inpatient general and vascular surgery and ranked the hospitals by risk-adjusted mortality. The expectation was that the best-performing hospitals would be the ones where less went wrong.…

In 2009, a New England Journal of Medicine analysis examined 84,730 patients undergoing inpatient general and vascular surgery and ranked the hospitals by risk-adjusted mortality. The expectation was that the best-performing hospitals would be the ones where less went wrong.

That is not what the data showed. Major complications occurred in 16.2 percent of patients at hospitals in the lowest-mortality quintile and 18.2 percent at hospitals in the highest. Overall complications …

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How to run a drill on your physician succession plan

Physician finance

You already run clinical diligence on every rollout

Your hospital recently adopted a new piece of technology. Maybe it was an EHR module. A patient monitoring upgrade. A documentation tool. A new device in the OR. Think about what happened next. Some of your colleagues embraced it. Others…

Your hospital recently adopted a new piece of technology. Maybe it was an EHR module. A patient monitoring upgrade. A documentation tool. A new device in the OR.

Think about what happened next. Some of your colleagues embraced it. Others resisted. The nurses figured out workarounds within a week. The IT department sent three emails about training sessions that nobody attended. Six months later, half the staff is using the new …

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You already run clinical diligence on every rollout

Physician finance

Closed-loop referral management needs a defined owner

A radiologist flags something on a scan that shouldn't be there. The physician sends a referral to oncology that same day, the kind where a few weeks genuinely matter, not the kind you let sit in a queue. The system…

A radiologist flags something on a scan that shouldn’t be there. The physician sends a referral to oncology that same day, the kind where a few weeks genuinely matter, not the kind you let sit in a queue. The system logs it, and the chart shows it as clean and complete: sent.

Four months later, at a visit for something unrelated (a sore shoulder, nothing serious), the physician asks how the …

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Closed-loop referral management needs a defined owner

Physician finance

How to manage patient records requests and reduce delay

A patient records request arrives the way a supply order does. It comes in by fax, portal message, or across the front desk, and joins a queue behind every task with a patient sitting in a room. Two federal rules…

A patient records request arrives the way a supply order does. It comes in by fax, portal message, or across the front desk, and joins a queue behind every task with a patient sitting in a room. Two federal rules attach the moment it arrives, each on a different clock, and neither is enforced by the practice management system.

The result is a workflow most independent practices cannot describe in numbers. …

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How to manage patient records requests and reduce delay

Physician finance

Financial freedom for physicians starts with purpose

What if pursuing wealth and pursuing purpose aren't competing goals, but two essential components of a fulfilling career and life? When I speak to fellow physicians about their financial lives, the conversation usually focuses on either: The strategies and tactics…

What if pursuing wealth and pursuing purpose aren’t competing goals, but two essential components of a fulfilling career and life? When I speak to fellow physicians about their financial lives, the conversation usually focuses on either:

  • The strategies and tactics of building wealth
  • The purpose to which we would devote our lives if money weren’t a factor

It is rare that I have a conversation that encompasses both. And it’s not …

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Financial freedom for physicians starts with purpose

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