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The Bigger Picture: Your Future Is in Your Hands
By Pamela Moore

Iím just back from a round of how-to business lectures to  physicians. I have to say, the experience is getting to be a little dispiriting, even for an energetic, glass-is-half-full person like me. Itís just room after room of hollow eyes and anxiety-driven questions.

The rare innovators  and bright-eyed optimists stand out like shining beacons. I love you guys, but geez you‚íre depressing.

Donít get me wrong; I empathize.

Itís absolutely true that reimbursement is bad, compensation is too low, risks are high, and all the rest. You have every right to feel the way you do. Whatís worrying is the sense I get that some of you are just so used to it that  you arenít seriously trying to find solutions. I seem to meet more and more  physicians in a downward spiral so overwhelmed that they donít have the energy to, say, figure out whatís going on with their collections. One primary-care physician, who started our conversation asking questions about Medicare billing, ended up angrily challenging my assertion that there are some contented family physicians. She has given up trying, but still plans to keep practicing the same way.

Iím not the only one to notice such patterns. Charles  Bond, a partner with the law firm Physiciansí Advocates in Berkeley, Calif.,  says the level of despair among doctors is worse now than heís ever seen before.  He wonders why such intelligent professionals seem so paralyzed when it comes to thinking differently about business.

A dispirited acceptance of oneís individual fate seems to be the dominant mood of physicians nowadays rather than a motivated mobilization toward a better lot for the individual practitioner and the profession as a whole, he writes in a recent article for Medscape entitled. The Training of the ėHelpless Physician. His hypothesis is that the world of medical school and residency depends on subservience and delayed gratification. It trains physicians just to accept it, at a certain level, if things arenít  working out. More education about business in medical school would help, as  would a change in the culture of medical training, emphasizing empowerment.

Changes to Americaís reimbursement systems could shake things up, too,  but proposals from the most promising presidential candidates from each side would hardly do more than stir the surface of the brew. Regardless, if youíre waiting for politicians to come along and fix everything, I think youíre in  for a very long wait. So why not fix things yourself? Not the system as a  whole, perhaps, but just your own small corner of it. You donít have to allow  your happiness to be subject to forces outside your control. So donít.

It may be naive of me, but I keep thinking that part of the solution is just for each physician to take matters into her own hands and shape a practice that makes her happy.

Itís just a business at least when it  comes to the issues that so bog down physicians. You can make it what you want.  There is little in the way. Hate managed care? Stop taking it. Want to see fewer  patients a day? Well, take a look at how you could lower expenses or change your  model to make it possible. Love your Medicare patients? Fantastic. Devise a business plan that makes it possible for you to keep seeing them. The only joy I  see is in practices where physicians have innovated, focused on what they love, and remained inspired.

Itís in your hands.

Pamela Moore, PhD, is senior editor, practice management, of Physicians Practice. She  can be reached at

This article originally appeared in the February 2008 issue of
Physicians Practice.

This article originally appeared in the November 2008 issue of Physicians Practice. Reproduced with the permission of Physicans Practice. Copyright (c) 2008 Physicians Practice Inc. All rights reserved. Republication or redistribution of Physicians Practice content, including by framing, is prohibited without prior written consent. Physicians Practice shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.


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