Ask a physician what the biggest business risk to their practice is, and most will land somewhere familiar. A lawsuit. A bad payer contract. A denial spike that guts a quarter’s revenue.
It is none of those. For a solo or independent physician, the single biggest risk to the practice is the physician’s own unavailability. Not the clinical kind anyone insures against. The plain fact of not being there to run …
The biggest risk to your practice is you
I have previously written that “not all physicians are nice.” Some physicians (a tiny minority) in private practice hold out the promise of partnership, paying physicians below-market wages until they get to the golden ring. Then, they terminate these physicians before they are made partners. As I noted then:
I have been representing physicians for over forty years, and the vast majority of the people I work with are genuinely …
The partnership offer that cost her $325,000
Most independent practices renew payer contracts the same way they sign them: the renewal letter arrives, the practice manager forwards it to the physician owner, and either someone signs it or no one does. The contracts that escape renegotiation for three or four cycles are the ones quietly anchoring 20 to 35 percent of commercial volume at fee schedules that lag the practice’s best contract by 15 to 25 percent.
The …
Run a payer panel audit before renewal season
I did not encounter Norman Schwarzkopf’s leadership doctrine until long after I had already been living it. When I finally read his words about sweat, preparation, and the courage to act despite uncertainty, I felt an immediate jolt of recognition. It wasn’t admiration. It was recognition. I realized I had been following the same principles instinctively throughout my medical and institutional life, especially in the moments when leadership and command …
What quiet leadership looks like in a broken system
A patient came to me worried she was going to lose twenty-five pounds in the next month.
Even on tirzepatide, what would make her think that? She’d only lost five pounds in the first two months.
She said the marketing that brought her in had promised her thirty pounds in three months.
So I explained the truth: the body does not save up its losses and then spend them in a lump sum. …
Why doctors need to be in the marketing room
Hospitals would never rely on the idea that “we know good care when we see it” to control infections. Yet when choosing leaders, many still rely on the vague belief that “we know leadership potential when we see it.”
Medicine reviews nearly every process that affects patient care. But choosing leaders often happens privately, through conversations, informal nominations, search committees, and personal opinions about “fit.” This process is rarely reviewed as …
Leadership diversity is a governance problem, not a slogan
It was two in the morning and I was starting a heparin drip on a patient whose clot was not going to wait for daylight. I typed the order, the electronic health record (EHR) flagged the weight-based dose, and minutes later a nurse hung the bag and programmed the smart infusion pump at the bedside. The pump beeped, the number climbed, and I moved on to the next patient without …
The business of medicine was never on my syllabus
Historically, followers have been positioned as subordinate actors, defined more by compliance than by contribution. In contrast, leadership roles are associated with an assumption of power, which may be formal, positional, and at times authoritative. This dichotomy is misleading. Many individuals in formal leadership roles experience constraints in their ability to effect change, as authority alone does not reliably translate into influence. Conversely, we all know individuals who are “not …
Undercover leadership: influence without the title
Most operational decisions in an independent medical or dental practice are made under time pressure with incomplete information. Hiring a practice management consultant is the decision practice owners turn to when they recognize that the operational gap exceeds their capacity to close. The mistake is not the decision to bring in outside help. The mistake is signing an engagement contract before disclosing what success looks like and verifying that the …
How to evaluate a practice management consultant
I enjoy building LEGO projects with my grandchildren, because it is possible to sit with a grandchild for several uninterrupted hours, unlike video games or watching them scroll on cell phones. Our last project was a LEGO Technic set, which lets the child learn about engineering principles like cams, levers, and fulcrums. This project was estimated to take 7 to 8 hours to complete. We made the mistake of misplacing …
What LEGO taught me about attention to detail
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Clinicians are treated as invincible, so when their own mental health suffers, many stay silent. Namit Choksi, a physician entrepreneur and health care executive, joins to explain how credentialing forms and a culture …
How credentialing fears harm physician mental health [PODCAST]
The best investment I ever made didn’t start with a pitch deck. It started with a nurse spending two hours on a task that should have taken ten minutes.
I was rounding as a hospitalist, and I noticed, again, the amount of time clinical staff spent on manual equipment checks, compliance logs, and inventory reconciliation. It was the kind of operational friction that becomes invisible when you see it every day. …
Why health care investing should start at the bedside
Most independent practices treat HIPAA as a documentation exercise. The policy binder sits on a shelf, the privacy notice is posted, the staff training certificate is in the file, and the assumption is that the practice is covered. Enforcement patterns over the last several years suggest a different exposure model. The settlements that reach small practices are rarely about the policies that were missing on paper. They are about the …
HIPAA compliance for small practices is not paperwork
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Today, many physicians will be considering applying for employment at a hospital or clinic. You might be one of those. Finding your next employer is the most important decision you have made since you entered medical school, because selecting the wrong one may end your career as a doctor. And even if a bad employer choice does not end your career, you may have a difficult experience in re-starting your …
Why the wrong physician employer can end your career
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Doctors spend over a decade training and then quietly leave a fortune on the table when they handle their own money. In this episode, economics professor Hernan Moscoso Boedo explains why high income and years of schooling do not make physicians good …
How fear of the stock market quietly costs doctors a million dollars [PODCAST]
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Most physicians who feel stuck in a job could actually afford to leave. They just can’t stomach what the worst week might look like. Stanley Liu, cardiologist and fiduciary financial planner, discusses the KevinMD article “Physician career choices come down to …
Why physicians stay in jobs they could afford to leave [PODCAST]
I arrived in the United States from India with one goal: become an excellent physician. That was the entire plan. Get through residency. Pass your boards. Build a clinical reputation. Publish research. Maybe land a faculty position at an academic medical center. Stay on the path.
For immigrant physicians, the path is narrower than most people realize. You don’t have a family network in American medicine. You don’t have alumni connections …
Immigrant physicians can do more than practice medicine
As physicians, regardless of our specialty, we share a singular, defining orientation: a fiduciary commitment to the patient sitting in front of us. Whether we are operating on a heart, managing complex diabetes, or counseling a family through a life-altering diagnosis, our patients grant us extraordinary latitude. They do so based on a deeply held understanding that our clinical judgment will be exercised solely in their best interests. This sacred …
Administrative harm is the burnout we don’t measure
René Laennec invented the stethoscope in 1816 because he was uncomfortable placing his ear directly on a young woman’s chest. Werner Forssmann performed the first cardiac catheterization, on himself, in 1929, threading a catheter through his own arm into his heart because no ethics board would have approved it on a patient. Graeme Clark developed the cochlear implant after watching his deaf father struggle to communicate. Charles Kelman revolutionized cataract …
Why physician-led innovation in health care stalled
Slow collections in an independent practice are usually treated as a billing problem. The vendor gets called. The workflow gets reviewed. The staff gets reorganized. The denial rate gets a quick check and is reported as a single number for the month, something between 8 and 12 percent. That headline number, by itself, is the wrong metric. A 10 percent denial rate that hides which payers are rejecting, which CPT …
Denial rate segmentation finds your real revenue leak
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