In nearly 30 years of visiting independent pediatric practices all over the country, I’ve learned that the biggest challenges that confront you are self-inflicted. That’s right—more than the insurance companies who behave like organized crime, more than the government mandates that force you to click nonsensical boxes in your electronic health record (EHR), and even more than all the ridiculous paperwork and cuts to Medicaid—the most important business problems you face start in your own office.
Too many pediatricians fail to operate like the small service businesses you really are. In your exam room, you are in control and get immediate, positive feedback about the work you do. However, making changes to your small business isn’t easy and your practice gets stuck in a rut.
Being a good, or even great, pediatrician is no longer enough to be a successful pediatrician.
Why do good independent pediatricians fail to be successful? How can you get out of the rut?
1. Focus on preventive care and chronic disease management.
This topic alone could fill an entire issue of Contemporary Pediatrics. If your practice depends on 100ËF fevers, runny noses, and diaper rashes to fill your schedule, your days are numbered. The retail and minute clinics of the world will gladly take those visits from you. You need to focus on the distinctive competency of pediatrics: well visits and, to a growing extent, helping children manage their chronic conditions such as asthma, obesity, and mental health.
Your connection to parents and helping them raise healthy children are the most important things you can do to stay clinically and financially viable. Preventive care pays well; fills your schedule; is required by your payors; is a crucial part of being a patient-centered medical home; establishes your position as the trusted medical source for your families; and, most of all, it is good for your patients.
2. Do your homework.
Do the small businesses you see on your way to work ignore the data that drive their businesses? Not if they want to stay open for long. Every real estate agency, gas station, and restaurant does its homework to survive. They look at their financial reports on a daily, weekly, monthly, and annual basis. They benchmark their performance against themselves and their peers. They know their targets and they can predict future success and challenges.
If you don’t understand your data, you are in trouble. Who really is your best payor? How much revenue do you generate per visit? What is your well-visit coverage really like? How many opportunities do you miss to provide screening? When is the last time you calibrated your pricing? Are you paying too much for vaccines? What are your staffing ratios? Is your billing staff adjusting off too many charges?
Most importantly, don’t answer any of these questions about your practice based on how you feel. It’s time for evidence-based practice management. You use many different measures to care for your patients, from vital signs to lab results. Can you imagine working without that data? Apply the same thinking to your business.
3. Stop hiding in your office.
Every year, there are a limited number of amazing opportunities to get real, pediatric-specific practice management training and instruction. In addition to the American Academy of Pediatrics (AAP) services, such as the Section on Administration and Practice Management (SOAPM) and their website, there are publications, including Contemporary Pediatrics, and a variety of pediatric practice management blogs you must read.
More importantly: get out of your office. Go to the AAP National Conference and Exhibition or one of the state chapter meetings with good practice management content. Attend one of the handful of private pediatric-specific conferences and events. Check out your EHR vendor users’ meeting. It doesn’t really matter where you go, just get out of your office and away from the safety net of your exam room. All it takes is one good coding or management tip to pay for a few years’ worth of meetings.
Don’t stop there. Have a friend from residency you haven’t seen in years? Call him or her and go visit. Spending a day or 2 in an office that isn’t yours will overwhelm you with ideas for change in your practice. Problems you’ve never been able to solve (or, worse, never knew you had!) will suddenly have solutions. Stop practicing in a silo; go visit a peer.