The single most valuable thing I have learned

His business training made our CPA more astute in the daily issues of operating an office-which had nothing to do with the actual practice of pediatric medicine. Every business, be it a furniture store or a mom-and-pop grocery store, must deal with these issues. Since his arrival, he has coached us into understanding "return on investment" and other business concepts that have altered our appreciation of what works for our clinic. Additionally, his nonmedical viewpoint was refreshingly honest, giving a real-world perspective that we might never have entertained.

Oftentimes, our decisions were based on "gut instinct" or personal bias. Now we participate in logical analysis, projecting how our decisions might affect our bottom line. Then we reassess, expanding projects that thrive and abandoning those that fail our financial forecasts instead of emotionally clinging to them as we might have in the past.

Good CPAs are not cheap. However, through cost-cutting maneuvers such as purchasing co-ops, renegotiating contracts, and increasing accounting efficiency, our CPA has more than paid for himself. There is a medical language that the CPA must learn-procedures, vaccinations, laboratory tests, CPT codes, and so on-that require daily attention. Nonetheless, these are subject to the same basic marketing principles that drive any service-oriented business-easily within reach of an experienced accountant.

An unforeseen benefit noted since the accountant joined our team is that we are more focused on clinical efforts. We waste less time struggling over administrative decisions, having fewer "summit meetings" to wrestle over "which photocopier to purchase." Our decisions are much cleaner, more clear-cut. Now, before decision-making, a cost analysis already has been crafted. Rarely is there controversy or muddled understanding over what choice we should make. What used to take 2 or 3 meetings, often spilling over into patient appointment times, now takes only minutes to decide. These precious saved minutes repeated many times over in a typical year are rechanneled into what we do best-taking care of pediatric patients. We find this makes us happier, but the unexpected bonus is that our families have noticed that we seem less stressed since our CPA has come aboard.

Today, instead of struggling over whether to hire an extra nurse, our CPA returns with a "dollars-and-sense" answer. To justify the cost of another RN, I would need to increase my appointments by 9 per day-just to break even. There. Decision made.

I truly enjoy pediatrics even more now, securely knowing that there is skilled business-oriented support looking over my financial shoulder, ensuring that we still will be in business next week and next year.

I wonder how well our 401(k) is performing. Oh, yes, our CPA shared that last week! See what I mean?

DR BRADSHAW is a pediatrician and founding partner for Pediatric Clinic P.A. at the Titus Regional Medical Center, Mount Pleasant, Texas, and medical director for pediatric advanced life support at Texarkana College, Texas.