The Business of Private Practice with Chip Hart

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Hi docs.

Welcome to the Entre MD Podcast where it is 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 doctor Una. Welcome back to another amazing episode of the Entre MD podcast. And I am so excited today. I think this is my favorite episode so far because I have the privilege of introducing someone who I can now call my friend Chip Hart. And this is gonna be absolutely amazing. So Chip Hart, I've followed for years. He is the director of Pediatric Solutions at pcc which if you're a pediatrician and you run a practice, this is the ehr. You should be looking at his physician's computer company and he's the director there. And I'm going to let him tell you all about him. But what I do want to say is that when it comes to running a business, running your practice, he is a literal genius. And I can say this, that it's not just about the financial part of stuff, is the clinical part of stuff. So you're providing great care to your kids and your practice is thriving. So it's almost like he has two patients, you, the business owner and your patients. But he's really great. And we're going to be talking all things the business of private practice. And if you own a practice or you want to own a practice or you think you may think about Rhode practice. You need to be listening to this. So, Chip, I am so happy that you are on here. Thank you so much for coming on the show.

Well, the pleasure is distinctly mine. I told you just before we started rolling, I've been looking forward to this all week because you sent me some prep questions to outline what we're talking about. And there are things that, as you know, I get all excited to talk about. Yeah, I'm grateful for that introduction, too. I think it was a little strong, though. I wouldn't mind if you went through it again. Maybe I'll cut that part out and send it to my wife. I can say, see, I'll send you the audio. Yeah, that'd be perfect as a background. You hit the big points. I mean, I've been doing this for 30 years. My focus is really pediatricians, but pediatricians really are part of that primary care spread of people. And that's what I feel confident talking about. I do a huge amount of practice management consulting. That's what I focus on. I help people open their practices. I help people make their practices more healthy and stronger. I help them. The big thing I try to do is help them wake up to the potential that they have. Which makes me. I don't want to sound all Tony Robbins today, but the longer I've been doing this job, the more I've moved away from, or not moved away from, that might be too strong, but the less I concentrate on the numbers. You know me, I'm a nerd. I will talk numbers all day long. I concentrate less on the numbers and more on actually the feelings that people have. Because what I've learned is that there's a small segment of our population who is motivated by numbers. I'm one of those people. Again, I'm a nerd. But the larger segment of our population, in fact, almost everyone is motivated by how they feel. And I've been spending a lot of time lately talking about how people feel. And in fact, next week, I know your presentation here won't be out in time, but actually not next week. In like three days, you and I are going to be teaching classes, different classes, but related classes about this subject down in Miami.

Yeah.

And have you seen my class about whether or not you work with the right people yet?

I have. At a users conference.

Oh, yeah, that's right. You're at the user. I've gone from slides that were all graphs and tables and numbers to slides that are just pictures. And I'm finding that the impact I have is a lot greater when I do that, which is really weird for me. I like to prove stuff with numbers. But we're going to talk today about feelings, I think. And not just feelings, but sort of process questions. And I'll call them little daily affirmations, things that you need to remember as a physician that are so easy to forget when you're in the grind, seeing patients and having to manage your staff, and you get home at night saying, what the heck am I doing? And it takes someone like me who's outside of it all to give you some perspective. I just want to say, though, as an aside, I'm not sucking up to you at all. I love the fact that you, as a physician, as a mom, as an entrepreneur, not only have the time, but are making the time to have the discussions like this, because you are an inspiration to so many doctors I know who are afraid to reach their actual potential, which is sad. And so that's why I was like when you said, hey, do you want to be on my pocket? Are you kidding? Like, I'll do this every day.

Thank you, Chip. You know, that means a lot coming from you.

There are so many people who. This is actually one of the things we're going to talk about. If you are, I'm sort of totally jumping the gun of our agenda, so.

Forgive me, Go for it.

For you to get all the way through med school means that you dedicated so much of your life and your energy to working hard. You know, you could say different things about physicians. The bottom line is, if you're a pediatrician, you're not afraid of hard work.

Correct.

And hard work is really the only thing that separates somebody who's working for the man. And whether that's a hospital or another physician or some sort of healthcare organization, that's the only thing that separates those people from people who own and run their own businesses and actually live the lives that they've always dreamed of. It's only hard work. And the thing is, people are afraid of it. Even though, as a physician, you have proven time after time that you're capable of.

Yeah.

And in fact, what's funny is that the hardest part, I think, of opening a practice and running a successful practice practice is the HR part. And you know, that is we're going to get. I'm doing this all out of order, but I just can't help myself. The hardest part of owning and running a business is managing staff and managing people. And the irony, if that's the right word, is that pediatricians are probably among the specialties, arguably the best at working with people and understanding people. It is like a skill set that you have. And so pediatricians, I think, in many ways are designed to be better and more successful and more efficient and more humane practice owners than many of other physician peers. Yet pediatricians often feel less confident doing that work when, in fact, you actually have more of those skills than, say, an orthopedic surgeon, who, as we all know, they tend not to have great people skills. And so I sit here frustrated, jumping to the punchline all the time, because I'm just like, I want to grab pediatrician and say, you can do this. It's not as hard as you think. So that's what we're going to talk about. I'll shut up for a minute and let you. Let you go, let you run with it.

But I'm very glad you brought this up, though, so, you know, hard work, and maybe we're going to give that a little bit of direction today and show people what's possible. And, you know, that's what this podcast is all about. So before we jump into it, though, I want to ask you your thoughts. I think I know what you think, but with hospitals buying up practices and all the changes that are happening in the healthcare space, do you really think primary care practices can thrive?

So if I could click on a button on my laptop that made a picture of my head exploding, that's what I would do because I could lecture about this for two hours. Not only do I feel like pediatric practices can thrive right now, I think this is still the golden era of independent practice in pediatrics. Even though I can list, just like you, the 10 things or the five things that bring you down as a physician, that make your jobs challenging or demoralizing, that is so overwhelmed by all of the things that are positive about what you do, and so many people focus on the negative, it drives me crazy. So let me start at the beginning. Number one, just because you went to medical school and graduated is not a guarantee of anything. I do know too many pediatricians, even, who feel like, I got my md, I'm seeing patients, everything should be coming to me now. And getting a medical degree.

Can you rewind and just say that again? Because, you know, my phrase is your MD is no longer enough.

That's why I say, just because you have a. Just because you're a doctor doesn't mean anything. It is not a promise of anything. It's not a promise to money. It's not. It's not a promise to happiness. It's not A promise. The only thing it promises you is a better chance of obtaining those things if you continue to bust your butt. Period. Ask anyone who owns any independent business has nothing to do with medicine. There's nothing special about being a doctor, except you start at a higher level of revenue. Ask anyone who owns a flower shop. Ask the guy who runs the muffler place. Ask an attorney. Ask how hard it is for her to be an attorney. And ask someone who. Ask a software company. I know what that's like. The fact is, anybody who owns a business, that's hard work and being an MD doesn't guarantee you anything except for a bigger brass ring you can reach. That's it. And so your way of saying it is absolutely right. Being an MD gives you opportunities that other people don't have, but none of them are a guaranteed lottery ticket. A lot of people feel like, hey, I worked my butt off in high school, I worked my butt off in college, I got through med school, now stuff should be flowing to me. It doesn't work that way. In fact, if you haven't noticed those large entities outside, especially the hospitals, I will go on record as saying hospitals are not your friend. Hospitals exist to serve themselves, not the patients. As individual people, they are all actually trying to do the right thing. But a hospital entity does not want to put itself out of business, when in fact, that should be their job. We want to make our community so healthy. We want to have as few beds as possible, but no, that's not how they work. And so all of those entities are trying to take a bite of your pie. And if you want to practice medicine the way that you believe it should be practiced, if you want to have the hours you want to have, the only way you will ever get them is to do it yourself. It does mean that the pathway will involve more hours for you and more time. But if you do it right and you set it up properly, the only truly satisfied people I meet in this business are the ones who have control of their own work.

Love it.

And the thing is, if you committed to go to med school, you are at some level a type A personality. You trust yourself more than you would trust anyone else. You need to do the work yourself in order to approve it or say it was good enough for you. And you're in a healing art. You have committed yourself as pediatricians. You haven't committed yourselves to the money. You've committed yourselves to working with children. And the only way that you are going to actually truly feel intrinsically rewarded is if you do it the way that is, you're moved by and everybody else is going to try to get you to do it a different way. I'm being a little scattered. I apologize, because you asked me a question that hits me all the way in. So right now I'm starting to. I'm coming up with some language or a presentation about this. So you're going to. I'm practicing it out loud for the first time right here. It's really clear that one of the problems in medicine in my mind is a, a misunderstanding of the intrinsic and extrinsic rewards of not only being a patient, but of being a physician. A lot of physicians, a lot of the language, especially when we talk about value based medicine and so forth. This big wave that's coming, everyone's focusing on the extrinsic rewards of being a physician. Do I get paid enough? What are my hours? And so forth. And those are important. You do need to get paid enough in order to keep your business open in order to see your patients. That's unequivocally true. But the burnout that so many of my customers feel is related to the lack of intrinsic reward. They don't actually feel good doing the work. When you go to work, you get up in the morning, you drive into work and you see 25 kids and you go home and you're like, I'm not sure I made a difference in any of their lives. Someone else was telling me how to see them. I'm not allowed to refer them to the right people or I can't give them the prescriptions that they want. I have to write this awful chart note that, you know, I have to write it this way if I don't want to get sued by the insurance companies. I have to write it that way if I want to get paid by the government. I'm not actually connecting with my patients. And the only way, the only place that you can move any of those needles and feel good again about this amazing job that you have is if you are in charge of as much of it as possible. And I'm not aware of a way around it. It's totally contradictory to the way that human nature works. To take these incredibly high functioning people and then say, okay, now you have to totally color inside the lines. Yeah, it doesn't work. So I'm going to ask you, and I would love it if you do have some. Is anything I'm saying wrong? Like, am I when I say this stuff, I just start spouting it based on my Experiences, but I'm sitting in front of a pediatrician right now. Are you seeing anything different in this business?

I don't think anything you're saying is wrong. I like that you describe it that way. I've always described it as purpose, but you know, it's the same concept.

Intrinsic.

Yeah, that's so on one side you get paid, but other side you're practicing medicine on your own terms the way you wanted to do it. Right. So for some people it's, I want to have hour long appointments and I want to do a direct primary care type model, which is fine. For some other people they're like, I'm really concerned about this whole obesity thing and I want to chuck all this other stuff and I want to focus on this, which, you know, insurance wise.

That'S not quite going to work.

Right. And then, you know, for someone like me, I have a lot of extra passions and I have four children and it took me years of blood, sweat and tears to start a practice and all that. And I was like, you know what? I really want to be there to serve my patients twice a week.

Right.

And the other days I want to be doing other stuff. And that's my thing, which you can't put a dollar amount on that.

So do you feel fulfilled now having that's, I mean, to me that actually gives me goosebumps when I see someone set up a lifestyle consciously to suit their needs. So let me tell you something, I'll tell you why, when you ask me that question, is this a good time? Can pediatricians thrive? There are three or four major topics that you're bumping into there. Let me mention the other one. That's become a really, really big deal for all of us. But I just finally started to notice it. As you know, I do a lot of work with Suzanne Madden at the Vernon Group. She does a lot of work with startup practices. And every year she and I teach a class at the NCE about, I can't say it that way, but every year for the last three or four years we've taught a class about how to start a practice. And one day I was, you know, we were looking over the materials and one day I looked at, I was thinking about, I'm looking. I was going through the list of the startup practices PCC has worked with and I had a hunch and so I called Suzanne, I said, hey, can you count through? She's done like 80 startups, almost all pediatric, I think.

Nice.

In the last couple years. Okay, that's a lot yeah, and she and I already agreed, like, look, we're seeing more startup work now than we ever have, alright? I like pcc, I'm not joking. We are turning away practices. If you signed with us today, this is awful. I probably shouldn't announce this, but if you signed a contract with us today, you're not going online for eight months. That's how backed up we are. And mostly startups. But then I noticed something else. I said, suzanne, how many of your startups are owned by women? She was saying she knew right away, 92%. And I looked at ours and it was 88%.

Wow. Are you serious?

Oh yeah, I'm totally serious. And then I said, suzanne, how many of your startups are owned by people of color? Define that broadly. Okay. And she said, oh, a huge number. And so I looked into this. I actually have an entry in my podcast, you can find it and I'll send you the link. So when you, when you put this out on YouTube, you put the link into it.

I'll put it on the show notes as well.

Yeah, exactly. Thank you. I did a survey on sopim and I asked, I said, if you've started a practice in the last five years, send me some demographics. And I have some other questions too, like, so who do you trust for your practice management insight and so forth? It was really interesting, but what we found was that 90% of the people who replied, of course it's self selecting, this isn't an actual study, but a survey indicated that 90% of the practices were owned by women. I think the number, and I could be wrong, it's in the number, it's like 30 to 45% of the practices also starting up are being, are by self defined people of color. And that clearly 90% female, let's just call it 30% people of color. That does not represent your standard graduating medical school class.

It does not.

It does not. And so the first tidal wave, the women that had and you actually, the story you just told about yourself, about having four children and having a certain set of priorities that has become so abundantly clear to me and to us at pcc and it has caused us to rethink everything that we're doing. The way we talk about our work, the way we presenting the work, the way we're training. And the perfect example is the one you gave. So as a practice management consultant for 30 years, I can tell you 20 years ago, all my clients were guys and there were female pediatricians, but they were not running the show for the Most part, there were a couple, but it was generally, I'm painting a broad brushstroke. But it was classic for me to talk to, frankly, three or four white guys at. Older white guys at every practice I went to. And it meant that when someone came to me with a question about how to run the practice, the framework that I would provide an answer was always, if you had 60 hours to work on this practice every week, how would you run it? And that was not a question you.

Want to ask me.

So I literally would say, all right, here's the thing. If you had come to me two years ago, three years ago, before I started to become conscious of this and said, chip, how do I run my. What do I need to do in my practice? I would have said, here are 37 answers. You got to fix this, this, this, this, this, this, this, this, this, and this. And it was in the middle of a consult I was doing recently where I had a practice, solo female physician, wonderful woman outside D.C. working her butt off. She's got a great practice. She's doing it right. And she had said, ship, what can I improve? And I gave her 20 things. And I sat down with her, like, a month later, I was in her practice, and she'd done, like, two of them. And I was like. I was geared up for the answer, like, why haven't you done these? And all of a sudden, it was like this. It's a small, stupid thing. But the switch flipped in my head. I'm like, wait a minute. I gave her 20 things. But guess what? Items 3 through 18 were not nearly as important as her kid. And so what I really needed to do is give her 20 things and say, but let me prioritize them for you. Let me give you one or two things to work on that are also going to give you purpose, because you don't have to work on number 17. I'm in the mobile if I see anything that isn't perfect.

Yeah.

And so instead, what I've been doing is I've been giving advice sometimes to female pediatricians that, in fact, is hurting them, because I'm just pointing things out that aren't perfect. And is your practice perfect? No. No one's practice is. It will never be perfect.

It will never be.

But is your practice good? And are you doing good things to patients or for patients? Yes. And so that little change, that dynamic change of me saying, instead of saying, Here are the 50 things that are imperfect about your practice, how about coming back and saying, here are three things that you're doing well for your family and for your patients. And here's how we can make one of those better. To me, that was like a lightning bolt to my brain.

Wow.

When you ask me, can the pediatric practices thrive? Absolutely.

Absolutely.

Do I think they're being run by women? Yes. Do I think they're being run by people of color? Yes. And here's the last part. Do I think that more and more of them often returning home, but when not at least driving to places that historically have been underserved? There is an army of high Medicaid, high volume practices, A lot of women returning to the neighborhood they grew up in, knowing that these are people who need to be served in art. They found their purpose. Now they're looking for their business. And I'm like, if it's not a golden era, a golden time to be a pediatrician, it's a golden time to be a pediatric practice management. Because the purpose that we get at pcc, helping these practices serve underserved populations is profound. It makes us all feel so much better about what we're doing. We're actually indirectly. I mean, we didn't go at school. We're not actually talking to the patients, but we are indirectly saving patients lives. And that to me is awesome. We have to PCC and other vendors, we have to pivot to make the experience that we provide practices like you affordable. You know, you know what we do. What we do is very concierge level. Everyone is very personalized. We know our practices really well. It's a much deeper relationship than most vendors. I mean, I don't know any vendor who works the way we do.

Can I interrupt you for a second? Hold your thought, though. Don't lose it. I just want to say this. I think this was the week of Christmas. Just to your fact, to the statement you just made. Sasha came to my practice like, oh, we just stopped by to say hi and see how you guys are doing.

And all this stuff.

I wasn't there that day. My practice administrator was. And it was like, I mean, we talked about it for a week. We're like, oh, my gosh, they could have been in the neighborhood there in Vermont. We're in Atlanta. But it was huge. And the practice administrator had talked about things that were going on, things that we were having some challenges with. And he sat to work through that and get us some appointments scheduled. And I just want to say it is concierge level. I mean, that was. That was huge.

Sasha, I haven't spoken to Sash about that, but I will Guarantee you he gets purpose out of the work he does. And he looks, he's on vacation or whatever, and it's like, oh, I'm going to be down near one of my clients. I should go say hello. Don't you feel the same thing when you're at a grocery store and you see one of your good families and they come up to you and they're so happy to see you and you know, you're like, I haven't done anything special for them. I'm doing what I know how to do. But that feedback loop, that reward, that intrinsic part is so important. And in medicine, we've lost sight of that. I think it's difficult, it's hard to measure, but you know it when you feel it. You know you know it when you see it. And so PCC has to figure out how to bring that level of self service, or if it's not that level of service, at least some level of attention to more people for less money. The expensive part is people, you can't do it with a chatbot, you can't do it with a computer. You have to actually have one on one conversations. And that's expensive.

And so we're real life Sashas.

We're real life Sasha. So that's exactly it. And we're trying to figure out how to do that.

I'm happy to hear that.

Yeah. Well, you have friends who need help and it's a shame that we can't help everybody. Yep. All right, so there you go.

Well, this is giving, like, a lot of hope because even I'm feeling like, wow, let's do this right. So tell me what you guys have served thousands and thousands of clients, so tell me what your biggest practice transformation like. So from a business standpoint, the biggest practice transformation you've witnessed.

All right, so there are many. And I have to be a little careful because some of them involve being like so far in the wrong place that if someone. I don't want the wrong person listening to this podcast and saying, that was me, I will say this. It has happened to me so many times when I've given a talk and one of our clients will come up to me after and say, you know, I'm a little uncomfortable about you using us. Using us as an example. And I'm like, I wasn't even talking about you. I wasn't talking about you. I can tell you that on the financial side, rather than give a really deep one, which I will, if you'd like, I'll give you a couple Example ones. So that maybe someone listening can say, okay, that reflects my story and maybe I have some hope that one work. I've worked with practices purely on the business side where through a combination of, whether it's poor coding, poor pricing, poor understanding of the value of well visits. I have worked numerous times with small independent practices, let's say three, four doctors, and I have found an extra, I'm not exaggerating, 150 or $200,000 a year of revenue that they were leaving on the table because they weren't running their business right. Just that just purely they weren't seeing their patients the right way. And in a four doctor practice, $200,000 is the difference between everyone staying open and everyone sending their kids to college. I mean, that's $100,000 a year.

Multiple six figures.

Yeah, every year, year after year. I've done that so many times I can't begin to tell you. And I usually there's a process I follow with every practice I meet saying, I want data from you, I want vital signs. And I get certain vital signs. And I can point, I can say here, here, here and here. Turn that dial, turn that dial, turn that dial. There's $300,000 and people don't believe it until they do it. Wow. And then I can go back and point at it. And they're always like, oh well, I just thought the payers were paying us more. It's always a face palm. You're like, has that ever happened in your life? So I've done that a lot. I have worked numerous times. One of the things I've been doing a lot lately and these don't always succeed. There's one I'm working on right now that I'm really heartbroken by. But I've done a lot of work with practices who are doing secession planning, like what to do when you know the original physician is leaving and there are two people who are left. How do you manage that transfer? Because I've seen a lot of practices totally implode at the end of the day, you know, at the end of someone's career or practices who just don't have a plan. And I've done a lot of practice divorces and a lot of practice sort of the passing of the torch. I do a lot of that. I'm working on one right now that I'm in the middle of the transformation. I don't want to say I'm in the middle of the transformation. I do like none of the work, but I'm working With a practice right now whose transformation I think is going to be so profound I may do a case study on it. And it has to do with a practice with original owners and new owners. And the new owners are coming in and it's like they've bought a new house and they're both figuratively and literally repainting everything. We want new carpets, we want new walls, we want new accountants, we want new office managers, we want new staff. And the financial impact of this is going to be, I mean, I'll put it as a percent on a percentage basis because if I give you the raw numbers we'd have to get into, well, how many doctors in. It doesn't make sense. But imagine, I'm saying to you, imagine if we could increase your revenue by 20% while lowering your workload by 20%. That's a no brainer. So yeah, obviously you asked me for my biggest ones. That is not uncommon to see someone's visit volume drop by 5 or 10% and see the revenue go up by 10. Of course, I know plenty of practices who work really well I can't squeeze another couple bucks out of. So for those practices, the biggest transformation that I like to focus on is helping a physician go from the position that you're kind of in, which is a small, mild control freak who has to work her butt off, who goes to bed exhausted every day and to just get that doctor to a place where she's still working her butt off but isn't crying at the end of every week because everything is on her shoulders. If I can get those practices to understand, here's how you share some of the administrative duties. Here's how you can hire someone who can fill in for you in a couple of those places. Those smaller transformations, those are huge though. Those are the ones that like. And you know what, you know full well there are things that you do as a physician with families that are, they're almost exactly the same. Oh, I just explained to them, here's a healthy eating website. Here's. Let me, let me help you build a menu for the week. And guess what? If you follow this menu, cheat only three of the seven days instead of all seven days. It's a couple pounds a week and that's all you need. You are actually in a very similar business to the business we're in, which is we're in the business of change management and we're in the business of incremental changes. Compound interest is an enormous thing. I don't know if you've ever Seen any of the studies about how human brains don't actually really understand how compound interest works? People who do it for a living all the time know it intuitively, but they don't know it emotionally. And when you're a pediatrician, you are in the business of compound interest. You make a very small change that pays off 1%. You get 1% interest every year. 20 years later you wake up to a kid who's well adjusted, who doesn't smoke, who isn't obese. And that's hard work to convince people to make those 1% investments. And so PCC tries to get our clients to make those 1% investments. Just do this little change and five years from now you'll look back and say, how did I ever live that way? Yeah. So I hope that answered your question. I mean, if you want, I can tell you. I'll tell you a story. Okay, ready? Here's one story. This one was way back. This is one of the first times I did some conscious practice management work. It was like 20 something years ago. And one of the things that PCC does is PCC puts servers in all of our clients offices. And you know, we do cloud solutions, but we still like the server in our customers offices because it gives them control. Most of our clients come from bad divorces and they don't like someone else owning their data. We totally get it.

Yeah.

So I saw this opportunity. I had these two clients near each other in a mildly rural part of the country who both needed server upgrades, but I also knew their numbers. And so I volunteered to go on the road and do their server upgrades. And in both of these practices I had noticed that they were pricing themselves very poorly. Now this is still a really big deal for some practices, just, but just not like it was 20 years ago. 20 years ago people used the Magic 8 ball to come up with their pricing and they lost a lot of money. And you know, I've yelled at you. We yell at all our PCC clients, so.

Yes, you do.

Yeah. And so these practices were. They were priced so low like they had, they didn't have any science applied to their prices that as a result they were losing. I'll walk you through this in a second. They were losing six figures each. So I went to each of these practices. I did. I was on site at the first practice for two days, upgraded their server and I said, hey, before I leave, I'd love to just sit down with the doctors and walk them through some of their numbers. And they were kind of taken aback by this because they were like the it people never come to talk to us about the numbers. And I. I said, well, you know, it will be worth your while. I promise you, it'll be worth your while. And at both of these practices, both six doctor practices, it was. I remember at practice A, it was about 150 grand that they made the first year after we turned some dials. And at the second practice, it's about 130 grand. And that was 20 years ago. You can do the math. It's literally millions of dollars that we recovered for them. Now, the thing is, one of the reasons I like this deep dive, or I chose this story, is I remember going to the first practice, and the first practice had a number of older partners and one new partner. And when we met, I walked through the RVU system and I explained. I said, look, I will guarantee you right now you are actually pricing your well visits at a number that's lower than you would actually be directly reimbursed. And one of the older doctors said to me, so how hard is this to fix? How much work do you need to do? I'm like, I already wrote the. It'll take me 10 seconds to update your prices. And the doctor said, go for it. The younger doctor raised a hand and said, I have been asking you to do this, make this change in our office for the last six months, and you haven't listened to me once.

Wow.

This guy comes in. You barely know him, and he comes in and tells you to do this, and you do it in 30 seconds. And this doctor was really mad. He's like, what's the difference? And they never answered that question. But I can tell you, here we are 20 years later, and that practice is still thriving, and it is owned by that one single new doctor who knew what he was doing and realized. I can't speak for him, but he now owns that practice, and he's running it because his light bulb was on. And I'm sure that's a huge point, too.

Like, even when you're in employee mode or when you are a junior, junior partner that nobody's listening to, you should still be doing what you need to do and learning what you need to learn, because someday it could be yours.

Yeah.

At the end of the day, the business will fall to the business owner. It kind of works that way.

You know, you are even more right than, you know, I have. In the last two. The last two or three years, I've helped a. A bunch of pediatricians who never expected to own the business. Suddenly, who've woken up suddenly because sometimes it happens with an accident. They didn't realize they were being groomed. Sometimes the opportunity fell in their laps, and sometimes it was just time. Now all of a sudden they're like, wait a minute, I wasn't paying attention to anything.

Wow.

Oh, yeah. And so I have to sort of give them lessons and. Well, okay, I'll tell you a big one. Here's a. For people who are listening, who are in the position that you just brought up right now, let me tell you something I run into almost every time, and hopefully this isn't an issue, but this is something I want you to think of. If you are a doctor and you are potentially going to take over the management of the practice you're in or ownership of the practice in your next five years, I want you to be heavily involved in the hiring of anybody you add to your practice in the next five years. Because let's just say you are three years away from potentially buying into your practice or owning your practice. In the next three years, you're very likely to hire a new office manager or new biller or a new head nurse. And that person is going to be hired by the present owner, and that person's loyalty is going to be with the present owner, and that person is going to be shaped and cut and molded into the present owner's likes and dislikes. And how many times have I helped a practice transition and the staff doesn't work out because now the staff is butting heads with the new owners because there's a new sheriff in town and they don't like it. And I'm like, but it's your practice. It doesn't matter. And that is. I think I said fifth sentence today. The HR part is the hardest part.

Yes.

And so if you can plant a little seed today and be actively involved with hiring that new nurse, so that new nurse realizes, hey, I'm going to be your boss over the next 20 years. This person's going to be your boss for the first two or three, but I'm going to be your boss for the next 20. That's a concrete piece of advice I would give someone today.

Well, thank you. Thank you. I actually have a client that I work with who is. She has been a straight employee. And what we did was we set her up as an entrepreneur. So she's the one that's helping them roll out telemedicine. She's the one that set up their YouTube channel. She's on doing the speaking gigs in the Community and all that stuff. And, you know, we were doing that so she can set herself up to be made partner and all that stuff eventually. And over about seven or eight months, the boss calls her and is like, oh, we're going to work your new contract and we're putting in the partnership track. Right. And that's just.

Yeah, that was huge.

And we're like, wait, you didn't even have to ask.

We were building up our case.

I guess we don't need to use it. And that's, you know, because she took on that role even though she was straight salary. These are some of the things that we do have.

And she probably. And I'm gonna guess it made her feel better about her job even if she'd got. Never gotten that partnership offer for two reasons. Number one, she's learning new things. And doctors, most doctors love to consume. They like to be smarter.

Yeah.

So she's learning new things, she's getting new skills and all right. So she liked it for that. And if it turns out that that partnership offer never came, she was doing her homework for her own practice.

There you go. So it's a win, win, win situation. There's no downside to it.

So let me ask you, what was your biggest practice transformation?

Let me see. I think for me it was. It's a little intrinsic, if I can use that word. When I first started the practice, I was introverted, introvert, Terrified of marketing, terrified of going out of my practice, terrified of talking to referral sources. And I was just like, I'm a great doctor. You know, people should just come and I'll take great care of them. And so my biggest transformation happened when I got out of my own way. I realized like, okay, stop it. Okay. You're a great clinician, which means when they come through the door, you can take great care of them, but you have to become a great business person so you can get them through the door. I embraced going out to talk to people. I embraced speaking. I embraced doing Facebook lives. I embraced all these things. It was so nerve wracking.

I remember when you used to be quiet. I mean, at least around us.

Oh, my gosh.

It's interesting because I am naturally an infertility introvert too.

You're gonna have to really convince me on that one.

Oh, come on. Look at you. You're no worse than.

I agree.

But yeah, I'm gonna need some convincing.

No, it's. What I've learned is that when I do stuff like this or when I do the public speaking, it is a role I play, and it is not my instinct to got it to work that way. And I'm mentioning this because I think you hit on something that other people have worked on and studied, and I would love to just steal their content. How do you address the fact a big number of your listeners are undeniably introverts like we are?

Yeah.

And, yeah, I get told this all the time. Well, you know, I can't do what you do. And I'm like, oh, my gosh, if you understood how short a jump it is from what you do to what I do, I would be out of a job. I know for myself, the way that I have been able to. It's not conquer fear. I will at least say that I haven't had that struggle. Some people are really pathologically afraid of putting themselves out there, whether it's doing Facebook Live, whether it's. Whether it's speaking public or any of those things. I didn't arrive with a pathological fear of it, but I definitely was nervous and I was wired like everyone else is. I just found I didn't do this consciously, but in retrospect, what I realized is I just play a role. It's like I'm acting. I'm doing it right now. This is not my. Yes, in real life, I can get excitable, but it's always with a group, like one or two people. And so this is easy. I'm talking to you, someone I know. That's all I do. And so when I give a public talk, I back up. I do. I say almost the exact words you said to yourself, which is like, I'm good at something. So you said, I'm good with the patients. And I say to myself, well, I have the data. I know I have numbers, which even if they're wrong, at least it gives me a starting place, which is better than what everyone uses right now, which is just to say, well, I feel like something. Let's measure it, and let's start from there. So I start from a place where I'm confident, and then I just put a mask on and the rest. And it happens. You know this. It happens so fast and so easily. Some days later, you get back and say, oh, geez, I don't even know how I got there. And so I will say the hardest part of talking to you is stopping talking because you say, like two words, and it makes me think of 25 things. So if you're listening to this podcast and you want to be an entrepreneur with your life, we Just hit on, I think, one of the fundamental pivot points, which is, how do you take that first step? And the first step has to come from a point of confidence. What do you do well? All right. And distinguishing between what you do well and what you don't do well, those are two buckets. And then distinguishing between what you like to do and what you don't like to do, those are two other buckets. And the hard part, the hardest part of being an independent physician is working on the things that you do well but you don't like to do. If there's something you don't like to do and you don't do it well, don't do it. Pay someone else to do it. Yeah. If you do something well and you like to do it, build your life around as much of that as possible. And it's that last. It's that last quadrant. Things that you do well, but you don't like to do. That's the hard part. And you can actually train yourself to do it. So do I like to take the risk of standing up on a stage and making statements that someone might easily refute? No, I don't. It's scary. But I train myself to do it. And what you find is that there's a safety net under all of it. It's a very friendly place anyway, so.

Sorry, what you're saying is that in business, there's some things you're not going to necessarily like to do, and you just need to put on your big girl and big boy pants and do it because it has to be done. I think marketing will fall in that category for.

For most people. But marketing can be fun. Marketing can be.

Once you learn it.

Once you learn. It's not rocket science. The thing I have to remind doctors all the time is, like, you've already shown that you can do something that's way harder than this and stop being afraid. I will say this, though. I did ask you the question, what was your, you know, your biggest practice transformation? And I like the fact that you told us about your own. And that is something I want people to think about when they do this. Like, you know, here we are talking to, like, not me. I'm saying you. We're talking to you, an expert on practice transformation and being a physician. And the biggest transformation was your own. And what a good and amazing feeling that must be. I mean, think back to when you were in practice 15 years ago or whatever. Think of how different your practice is now. Could you go even back to the way it Was.

No, no. I was scared of everything. You know, I'm scared of spending money.

Yes.

I signed up for PCC two years after I first spoke to Chris because I was like, I can't do that. I was scared of hiring people because I'm like, then I have to manage them, because leading people is hard the proper way. So. Which means you inspire them to do great work. You hold them accountable for good work. You call them out when you're there for them, when things are falling apart, it's hard.

It's easy.

Just let people do that thing. And you're like, well, it didn't work out. You know, hiring and firing, I mean, that was hard. And asking patients for reviews or everything was just like, oh, my goodness. So it was almost like a handicap. So I was the problem with my practice. Every time better, everything got better.

You know, I'll tell you a story. 20 years ago, 25 years ago, PCC did a survey of our clients, and we asked the question. This is probably before your time. We asked a question. What are the biggest problems in your practice? What is keeping you from taking care of kids? And we took all of the answers, and we boiled them down at four answers. They were so consistent.

Oh, I want to hear this. Tell me.

Well, I got to remember them. All right? But you're going to laugh because we realized something. So the number one thing this was now keeping this is a long time ago, and things have changed.

Okay?

But the number one thing that our customers told us 25 years ago that was keeping them from that was a problem in their office was that their AR was out of control. The business office was out of control. That was number one. Number two, finding and hiring the right people is really hard. Number three, the hoops that the insurance companies make us jump through are really troublesome. And you know what? I'll think about it. But I can't remember the fourth, but I will tell you this. They all had the same pattern. When we ask doctors, what are the biggest problems that you have in your practice, no one says, I am. No one says, I'm bad at coding. I'm not good at hiring people. You know what they said? It's hard to find good people. Good people don't exist. Not, I'm bad at finding them, and I'm bad at leading them. No one said, and so an aunt. So PCC latched right onto the one that says, our AR is out of control. So I did the work. I mean, I was the one who did it. I was on that group and we ran all these AR reports and we did all this stuff. We used to send clients every quarter a full printed AR breakdown. Now it's on the dashboard. And you know what we learned? Our clients AR wasn't out of control. In fact, the first year we measured it, our clients had an average ar days of 3.32-which at the time the industry average was 45. Our clients are down to like 22 right now. Industry average is still, like in the high 20s. So what do doctors say when you say, well, what needs to be fixed in medicine? And they all say, somebody else.

Yep. Not me.

And the way the day that you wake up and say, there's only one person who controls what happens in my office and it's me, that is the day that everything changes.

I agree. That right there is profound.

Yeah. I'm going to point in the camera. So if you're watching this video, you know who the problem is? It's you wake up and you. And you have friends in this business, all right, you have PCC gives away, like, all of its consulting, all of our stuff is online. You've got you. You've got sopem, you've got your state chapter, you've got other practices, you have a thousand places to go where you can get help and guidance. And frankly, you can also just write a check and solve the problem. All right, the excuses are endless, but the reasons are few.

Oh, that's good. The excuses are endless, but the reasons are few.

All right, speed that up right now.

Well, you made up good. But I think one of the biggest things anybody listening to should take away from this is your biggest project is you. And once you start working on that, you know, everything changes. I've done a lot of bad hires, and I came to the conclusion that it's not the people you know. The problem is you don't know how to hire the right people. And, you know, once. And there are books on these things, there are courses on these things. And I went and I did those. And then I've been able to bring in really good people, you know, since then. And even my patients are like, thank.

You for the kind of doctors you're hiring now. They're amazing.

It's so funny. But, yeah, we need to work on. We need to work on us.

I think that's the class I'm teaching on Friday at pmi. The most important thing you can do as a business owner is hire well. And it's hard work and it takes some skill. But as a pediatrician, you actually have a lot of those skills. And I say this all the time. Good employees fix all of your problems, and bad employees create all of your problems. Anyone here who's in a business can point, especially when they own, and say, this employee caused more trouble than they fixed. And you need to have people on your team who are culturally aligned with you and who are willing to work with you, be on the same team. Those things are gigantic. I'll say this, actually, also, I mentioned at the beginning that I do, you know, I still do all the number stuff. I still do, you know, I just did my RVU calculator. I just did the analysis again. I can't help it.

I saw that.

Yeah, it's. It's important. But all my work these days is really targeted at or the things I've been talking about the most is your practice culture. I'm the older I get, and the more I work here at pcc, the more I realize practice culture is the single most important aspect of your leadership obligation. Establishing that culture, articulating it, making the people you, not only the people you hire, understand it. But this is crucial. Making your patients understand, this is who I am. This is what I offer to you. I am going to focus on this. And if you want to focus on this, come to me. If you don't want to focus on this, go to someone else. And the more patients you align with your vision and your values, the more staff who align with your vision and values, the more rewarded everyone is going to feel. I mean, I just see this over and over again where I walk into a practice with four partners, and I'm like, why are you guys all in practice together? You have totally different values. I would ask this if you. I'm not saying you personally, but if you and your husband are married and you want to have kids and he.

Doesn'T, you shouldn't have been married. That conversation should have come up before the fact.

Right. Well, but in our business, as you know, it never happens before the fact. In fact, in your business, it does have enough. But if your partners, if your partners in your business and you have very, very different visions for what that business should be accomplishing, why stay married? Why not break up amicably and help each other get on your pathway to success? If you can't figure out a way to do it together, then don't do it together. I mean, oh, my gosh, the number of practices I meet, who should be divorced and so everyone can be happy. Yeah, I would say it's 20, 30% of the time I go into a practice, I'm like, you know, three of you, three of you understand each other, one of you does not, and you should break up. But anyway, that's all right.

We're going to have to do part two because this is just fantastic.

This is the first I'm delighted to.

Be that I've had go this long. But this is so good. So at the end of the day, everybody should be leaving knowing that private practice is alive and well. And yes, there's a lot of bad things going on, but the good stuff going on totally outweighs that. And if a practice owner here and you're like, I want my AR to change, I want the people I hire to change. Just take a look in. Words is so much easier. So changing all those things, change yourself and everything else. Everything else follows. Now you have a blog, Confessions of a Pediatric Practice Consultants.

Yep, you got it.

And so I'm going to put the link to that in the show notes so everybody can check that out as well. I'll put the link to PCC as well. There's a tad bit of a wait, but I'm sure Chip will figure that out. If you're looking for a great ehr, but what would be your parting words to anyone who's listening, especially someone who's on the fence? I want to start a practice. I'm just a little scared. I'm not sure if I can pull it off.

Pick up the phone and get in touch with one of us, because if we can't help you, we'll introduce you to someone who will. Stop being a wimp. Get off the mental couch. Because I know you're working hard. Just get off the mental couch and ask about it. You know what if it turns out you're not made to own a practice? Wouldn't you rather know today and embrace being an employed physician? Because there's nothing wrong with being an employed physician. Embrace being an employed physician and stop beating yourself up over it. Maybe you just need to be an employed physician for another couple of years while your kids are in school. There's nothing wrong with that either. The other thing I'll say is this. If you've got questions, if you want us to address something, I would be delighted to do a second version of this because it's easy. I just. If you've got questions, if you want to gather that stuff and maybe come up with some stuff we can focus on, I'll be glad to do that. The other thing I'll give you, actually, I'LL give you some links because you and I talked a fair amount about. Do you work with the right person? Yeah, I'm pretty sure that pcc, I actually have a video of it. I give you the link to that at PCC so you can come watch the video as well.

Excellent. And I'll put that in the show notes. This is so good. Thank you so much Chip for coming on and for everybody listening. Hope you enjoyed this. And remember that we have the online community entre md.com join so we can continue the conversation there. And be sure to share this episode. There's somebody who's been thinking about private practice, pediatric or not who would love to hear it. Thanks Chip.

Thank you very much. I appreciate it.

If you love this podcast, please take a moment to subscribe, share and review it on itunes as you go about your week. Remember, you're not just an md, you're an Entree md. Don't forget to tune in next week for another great episode. Until next time.