September 4, 2025 • 47 mins
Are you a private practice physician feeling crushed by high overhead and low revenue? You’re not alone—and you don’t have to stay stuck. In this episode of the EntreMD Podcast, I’ll show you the proven steps to rescue your practice, lower costs, boost revenue, and finally build the thriving business you envisioned when you started.
You’ll discover the mindset shifts, practical strategies, and systems that will help you go from survival mode to profitability and peace. Whether you’re just starting out or you’ve been in practice for years, these principles will help you turn things around—fast.
Additional Resources:
- Learn more about my 12-month program.
- Interested in 1-on-1 coaching? Apply here.
- Grab a copy of the "The EntreMD Method" book.
When you are ready to work with us, here are three ways:
- EntreMD Business School Accelerator - If you are looking to make a 180 turnaround in your business in 90 days, this is the program for you.
- EntreMD Business School Grow - This is our year-long program with a track record of producing physician entrepreneurs who are building 6, 7 and 7+ figure businesses. They do this while building their dream lives!
- EntreMD Business School Scale - This is our high-level mastermind for physicians who have crossed the seven figure milestone and want to build their businesses to be well oiled machines that can run without them.
To get on a call with my team to determine your next best step, go here ...
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hi docs, Welcome to the EntreMD podcast, where it's
all about helping amazingphysicians just like you embrace
entrepreneurship so you canhave the freedom to live life
and practice medicine on yourterms.
I'm your host, Dr Imna.
We have a doctor in privatepractice who has a practice
(00:23):
where her overhead is so high,her revenue is a lot less and
she thinks that her privatepractice is at risk of failing.
Speaker 2 (00:31):
And so today, what we're going to do is take a look
at this practice, come up witha diagnosis, fix the practice
and give this doctor a strategyshe can start working with and,
right away, start seeing wins inher practice and, over time,
bring it from a place where itgoes from almost failing to
completely thriving.
Okay, so we're going to look atthis private practice.
This is going to be a lot offun If we haven't met before.
(00:53):
My name is Dr Una.
I'm a pediatrician by training.
I have been in private practicefor the last 15 years and at
this point I've technicallyexited my practice, if you will.
My practice is team-led andit's been that way for the last
five years.
And then I'm the founder ofEntreeMD.
I help doctors build profitablebusinesses so they have the
freedom to live life andpractice medicine on their terms
(01:14):
.
I am a huge advocate forprivate practice.
Private practice is not dead.
The old playbooks are and, yes,we have a lot of systemic
problems in the healthcare space.
But until we have enoughempowered physicians who can
then stand up to the system, weare going nowhere.
Okay, so I fully understandthere's a lot of things to fix,
but you know, when you get on aplane, they tell you, if the
(01:34):
pressure goes low, oxygen masksare going to come down.
You're going to put it onyourself first and then you're
going to put it on others, okay,so this is us putting the
oxygen mask on ourselves, okay,all right.
So when this doctor told me this, I said okay, I want you to
think about the top five thingsthat are creating this financial
pressure and financialchallenge you have in your
(01:56):
private practice.
And she sent me these fivethings, so we're going to
troubleshoot these five things,okay.
So the first thing was you knowmy reimbursement right from the
insurance company.
So this is insurance-based.
Private practice is low andslow.
Okay, so it's low and slow.
Money coming in, and we knowmoney coming in.
That's like the blood, if youwill, of the private practice
(02:18):
and all of those things.
So this is something that weabsolutely need to fix, okay.
So she gave me some context.
She said there's a largediscrepancy between insurance
carriers, and so you know.
So some pay you know well andsome pay very poorly.
She said I've already stoppedtaking Medicaid.
There are thousands ofoutstanding dollars after the
(02:38):
first year with Medicaid, andthen it's considered letting go
of TRICARE.
Okay, and again, because of lowreimbursements and all of those
things, and so this issomething that absolutely needs
to be fixed.
When you think about thepractice revenue, anything
touching it is like somethingtouching your aorta, like once
(02:59):
you bleed from there you'rebleeding out, right.
So this is something veryserious.
We want to look into it and wewant to fix it.
So I came up with somerecommendations for her.
Okay, these are things that shecan consider.
These are things that she cando.
Some of them will work fairlyquickly.
Some of them will work overtime.
I don't think that any of thesestrategies really that she
shouldn't employ.
(03:19):
Okay, so the first one I said islooking into joining a network
that manages contracting.
Okay, so, like an IPA, anindependent physician
association, or PHO, a physicianhospital organization, you know
, like one of these, and this isif she's not already a part of
it.
And why is that?
Well, because theseorganizations have a pool of
(03:41):
physicians within them.
They're usually able tonegotiate for better rates.
Okay, so there's so many peoplewho have had significant bumps
in their revenue just becausethey went from contracting
directly to contracting with anIPA right Now.
So if she hasn't done this,this will be a really great
thing to consider.
Chances are that it's not goingto bring an immediate
(04:02):
turnaround, because it's goingto be a process to go through
them and all of those kinds ofthings, but it's something that,
yes, it will bring a lot oftransformation.
Now I will say with this,because it has to do with your
money and the entire revenue ofyour practice, you do want to
choose carefully, right,everybody's going to sell you a
good game.
They're going to say, when youcome on, we'll do this, we'll do
(04:23):
that, blah, blah, blah.
They'll make all the promisesin the world and I'm going to
challenge you to find three tofive people who are using that
IP or using that PHO and go findout from them what the real
deal is.
Right, so you want to getreferences.
It doesn't have to be from thecompany.
It can be from the company orthe organization, or you can get
them directly like who's partof this network, who's part of
(04:44):
this network?
And you go interview and havereal conversations.
Okay, do not take anything atface value.
This is something that we do asphysicians and something we
want to walk away from doing.
Okay, something we want to walkaway from doing, which is,
whatever they said, we justbelieve them, don't.
You're an entrepreneur now.
That's not what we do.
Trust, but verify, right.
Okay.
So that's the firstrecommendation for reimbursement
(05:07):
being low and slow.
The second one is to audit thedistribution of patients and
insurance in the practice.
Data is a very beautiful thingbecause data will show you like
data preaches to you.
You see, the data automaticallybecomes obvious what needs to
happen, right.
And so you want to think likewhat are the top three
(05:30):
insurances my patients use?
You want to know what thatnumber is.
You want to know what thoseinsurance companies are.
You want to have a feel for it.
But, more importantly, you wantto know, like, based on the fee
scale, you want to organizethem from best paying to lowest
paying, right.
And then you ask yourself aquestion for the lowest paying
ones Am I even making money onthem, or is every?
(05:52):
Do I lose money with everyvisit Because we've had to drop
some insurances because theywould pay us lower?
Or the exact amounts that thevaccines cost?
And I'm like, if you pay me theexact amount that the vaccines
cost, I am losing money witheach vaccine I give because I
have to buy the vaccine, I haveto store the vaccine, I have to
pay staff to process the vaccine, I have to do all of these
(06:14):
things and so, yeah, and we havevaccine wastage.
I'm losing money on that.
And so you are an insurancecompany that is too expensive
for me to be in network with,like you're too expensive
because you cost me money, right.
And so you have to look like,am I losing money?
Or I'm just not getting as much?
Like, what is it right?
(06:34):
If you know like, and then youwant to consider dropping some.
If you need to drop them, right, if you need to drop them
because it's a business decision.
But you want to look and thenyou find out that most of your
patients are with a very poorpaying insurance company, then
the question then becomes do Iclose the panel and market
(06:55):
really hard and change thedistribution?
Now, this doesn't mean changethe philosophy of your practice.
For instance, my privatepractice is 60%, is about 60%
Medicaid, and at a point it waseven higher.
And I'm okay with it becausethat's what I wanted.
I, you know, I wanted apractice where I could people
who had really good insuranceand people who had Medicaid they
(07:16):
, you know, they could come,they get treated really well,
they have a great experience.
They have access to a doctor.
We had same day appointments,we had like all kinds of fun
stuff.
I wanted them to have that.
Now, what it means is I was alsoaware that I was playing a
volume game.
I, you know, like I didn't lieto myself.
You can't say I want to takeMedicaid and I want to see one
patient an hour.
Those two things cannot coexist.
(07:37):
The business will die.
It will die a sure death, right.
And so I'm like okay, I want todo that.
So the question then becomeshow can I go through the volume
and do it in such a way thatit's still a very personalized
experience where they felt likethey were heard and all of that?
Then I had to come up with thestrategies for people to have a
great experience, even thoughthen I'm not sitting with them
(08:00):
for an hour.
Do you see what I'm saying Like?
So it doesn't mean find thepeople, drop everybody.
That's not what it means.
But if you don't have the data,you don't know.
So I have 10,000 patients,wonderful Top three insurance
companies used by those 10,000patients.
You want to know what that is.
Then you want to have theinsurance companies top to
bottom, from best paying tolowest paying and lowest paying
(08:22):
is it lowest paying, like I'mmaking a little profit, or is it
lowest pain, like I'm losingmoney?
If you're losing money, you gotto drop them.
You got to drop them.
Okay, all right.
So that's the second thing wewant to do, this audit of the
distribution.
The third thing for this person,because her specialty lends to
it, is I'm like, but you want toconsider some cash-based
(08:43):
services and chances are, thisdoctor has either been thinking
of it or maybe has somecash-based services, but they
haven't necessarily beenpromoted and stuff like that.
And the reason why I broughtthis up because, with what this
practice is going through, itdoes seem like having an
immediate cash injection wouldbe really good for the practice,
(09:05):
and so if they're cash-basedverticals that already exist, we
want to go hard on those.
If they don't exist I mean forthis person's specialty there
are many that can just exist.
They can start today becausethis person is equipped to do
them.
They're hot topics, all ofthose things, so they can do
them.
Why Immediate cash flow andhigher margins?
Right, because you don't needthe bill or you don't need this.
(09:27):
There are a lot of things thatyou don't need, so I would do
that because and someone may say, oh, but this is so businessy,
we're just going to bring theseservices because of the cash.
No, we're going to bring theservices because it'd be high
value to her people and it willbring cash.
And if you're in privatepractice, I don't want you to
continue to be thrown off by theneed to make money, because for
(09:48):
your practice to stay open, youneed to make money.
We need to stop pretending, weneed to stop acting like this is
not an important thing.
I am fully aware that one ofthe best ways I serve my
patients is by stayingprofitable, because if I'm not
profitable, I have to go away.
Okay, okay, so that's that's.
The third recommendation is tolean into some cash-based
services.
Okay, again, cash injection,because this practice, we need
(10:10):
to get cash in.
The fourth thing is I wouldprioritize services that
increase the cashflow, and I'llexplain what I mean by that.
Okay, so let's say, forinstance, in my private practice
, if we say, oh, it looks likethe next two weeks that we have
(10:30):
open spots and stuff and we needto do something to fill our
schedule, so we need to beproactive as opposed to reactive
.
Okay, and I have.
Let's say, I have 300 patientswho are overdue for well checks.
Okay, now I know that I can'tsee all 300.
So what are we going to do?
We are going to call the peoplewith the better paying
(10:52):
insurance and we're going to getthem in.
What is that going to do?
It's going to give me a bettercash flow.
Now, you might say, but what ofall the other people?
Well, in my practice, we happento have a routine schedule for
sending out reminders to makeappointments.
So they have all had reminders,every last one of them.
Okay, we also do not let peopleleave the office without
(11:13):
scheduling appointments.
So for them not to have anappointment, it means that they
canceled the appointment or theyno-showed for an appointment
and we have not been able toreach them.
Okay, so are we reaching out toeverybody?
We are, but if I want to gohard and put staff time behind
bringing people in, I am goingto leverage what will be a
bigger win-win situation for allof us.
Okay, all right.
(11:34):
So for this doctor, you have tobe aware.
You have to be aware.
The services that I offer, topto bottom, from biggest revenue
generator to least revenuegenerator, do you do all of them
, sure, but in a situation likethis, where we're like, oh, my
goodness, something needs togive, you want to prioritize
(11:55):
those.
You're available for everything, but you prioritize those, okay
, all right Again, if this makesyou feel like, but it's about
the patient, of course it'sabout the patient.
That means you're treatingpeople differently.
No, no, no, no, we're not,we're not.
But seeing patients is theresponsible thing for a doctor
to do, and keeping the practiceprofitable is a responsible
(12:18):
thing for a doctor to do.
They're both responsible things.
So we're doing both.
Okay, all right.
The fifth recommendation thereI have is maximize daily
productivity.
Now, this is so, so, so, soimportant.
Okay, I will give an example.
I was talking to a doctor,someone that I really have a lot
(12:40):
of respect for, and all of thatstuff.
She's running a practice, shebuilt it from scratch, she's
doing an amazing job.
And then, while we were talking, she says you know, I don't
want to get burned out.
I want to see a certain numberof patients every day, you know,
because that's what I want tosee.
Okay, and then I said so.
(13:00):
And then she went on and I saidwait, wait, what is that number
?
How many patients do you wantto see and I asked this question
because I know she's aninsurance based model and so she
says I want to see 14 patientsa day.
(13:25):
No, your reimbursement isprobably not more than $150 per
visit.
So I'm like, okay, we're goingto do some math here.
Okay, so 150, I didn't use 150,I used 100 on that day because
the math was easier.
But let's do the real math.
Okay, 150 times 14 is 2100.
So I mean that your cap withyou as the doc there, your cap
is 2100 a day.
Okay, and you multiply that by260, you're at $546,000.
(13:47):
Now when I did the math with100, it was $364,000,.
Okay, so you're at $546,000before overhead.
That's the cap.
If your practice is like 60%overhead, which is not unusual,
(14:08):
your 60% overhead puts you at327,600.
So the question is then becomeswhat's left?
Right, what's left?
So this is what we need to lookat.
You have to know what thenumbers say.
You have to know what thenumbers say.
So when I did it with her anddid the math at a hundred, I
(14:28):
said you're at $364,000.
That's the cap.
That's the most your practicecan bring in before overhead.
Before paying you before anyprofit, you have to be sure that
you're okay with that number.
You see what I'm saying.
So for this doctor, I wouldactually have her look like look
back on the last two weeks onthe last month.
How many patients are youseeing every day?
Look back on the last two weekson the last month.
(14:51):
How many patients are youseeing every day?
What is the maximum amount ofrevenue you can create with that
?
Are you having more no-showsthan you thought?
Are you seeing less volume thanyou thought?
With the volume that you areseeing, what is the max per day?
Because if that max per day isa number that you don't want,
something needs to give.
Do you see what I'm saying?
If we don't do the math, badthings happen, okay.
(15:13):
So this is part of the reasonwhy we use in my private
practice, we use Practice Pilot,okay.
So Practice Pilot is a financialtracking software for private
practices and when you create,when you go in there, one of the
things you would do is it willhave you put your average
reimbursement per patient, okay,and then you create, when you
go in there, one of the thingsit would do is it will have you
put your average reimbursementper patient, okay, and then you
will set what your goal is.
(15:34):
So if you say my revenue goalfor this year is I want to bring
in 2 million, now, based onyour average reimbursement per
patient, it will tell you howmany patients you need to see.
And if you say, no, I don'twant to see that number, I want
to see this number, it will showyou how much revenue you can
generate.
And once you see those, there'sjust something about seeing the
(15:56):
data that lets you know like,wait, I don't like that number.
And then, if you don't like thenumber, the average
reimbursement needs to change orthe volume of patients needs to
something, something needs togive.
Okay, so I would have thisdoctor do the math with the way
you're functioning, what is thepotential amount of revenue your
practice can bring in every day?
This is a number you want toknow.
Okay, all right.
(16:17):
So that was the first thing.
That was the first thing.
My reimbursements were low andslow, okay.
Second thing my AR is out ofcontrol.
Okay, my AR is out of control.
So when we looked at this, okay, this was the number, this is
the number that she gave me.
Okay, she said over over 90days.
(16:40):
So from from over 60 days wasalmost 80% of her revenue.
90 to 120 days was 38% of herrevenue.
She has a lot of revenuesitting in her AR, a lot of it
and for older practices you mayhave that because maybe you have
(17:01):
bad debt from years and yearsand years.
So you're over 120 is bloated.
She's in her second year.
She's in her second year ofpractice, right, and so to have
that number, I would definitelymake the assumption that my
biller is not doing a good job.
You can even make theassumption that maybe your fund
desk people are not doing a goodjob, maybe the insurance
(17:23):
eligibility, I don't know.
But there are things thatyou're going to.
Okay, we need to look here Now.
So these are therecommendations I have based on
that.
First of all, I'm like you haveto treat this as a matter of
urgency and I would think of itlike somebody's bleeding out.
You're a surgeon, you havesomebody on the operating table
and this person is bleeding out.
(17:44):
Nobody's like calm andcollected and whatever.
Like we have something to fix.
Okay, so we're not frazzled,but there's urgency.
Okay.
When you have AR like this thisearly in the game, there's
urgency.
This needs to be fixed.
It means the practice isbleeding out.
What that means is you know wehave this thing of if we're
(18:04):
seeing a lot of patients, thatmeans you know if we're really
busy, it means the practice isworking.
No, no, no.
The evidence of the practiceworking is in the bank account,
because the fact that you saw apatient doesn't mean you got
paid for seeing the patient.
It doesn't mean that at all.
After seeing the patient, thereare processes that need to
happen before you get paid.
So this is what I have for herTreat this as a matter of
(18:25):
urgency.
Treat it like there's somebodyin the OR on the table bleeding
out.
If you know the level ofurgency you have with that,
you're still calm because youhave the strategy.
You know the algorithms and allof those things, but it's
urgent, it's urgent.
So one is treat it as a matterof urgency.
Two is meet with the billers todiagnose the issue and create a
strategic path forward.
What that means is you're noteven offering all the things
(18:47):
when you have a vendor.
Please understand that thevendor works for you.
Okay, they may not be your W-2employee, but they work for you.
And so you sit with them andyou're like okay, we have an
issue.
Okay, this is what our billinglooks like.
This is what the nationalstandard benchmarks are.
So somebody walk me throughwhat exactly is going on Like,
what is the core issue here?
Okay, the core issue here?
(19:10):
Okay, it can be more than three.
What are the top three?
What are the three core issueshere?
Or the one core issue here isusually not one, so let's say
three.
And what is the strategic pathto move forward?
How do we make this AR looklike this AR, like this national
benchmark?
Okay, now, billers have beenknown to blow hot air because
they know physicians don't careabout this stuff, physicians
don't want to look at this stuff, physicians will not ask
(19:31):
questions.
I literally had a client whotalked to her biller like I want
us to meet and do all this, andshe's like no physician's ever
asked to meet with me.
I was like, ooh, we're in theon-term deal world.
Of course.
We ask this is the era of thepractice, right?
Okay, so what is the issue?
And when they tell youhighfalutin things, you're like,
break it down, break it down.
(19:51):
Like I'm a doctor, like I'm athird grader, like make it make
sense, but don't just acceptanything, right, don't just
accept anything.
The diagnosis needs to makesense to you.
The strategic path forwardneeds to make sense to you, okay
, so have them come up with it.
Create a strategic path forward.
You want to lean into it?
So I've taught about this inthe profitable private practice
(20:13):
movement, like you know how tolook at these things at all.
You want to look at it?
Okay, all right.
Then the third thing is afteryou're done with that meeting,
things will change.
If you do this thing, which isto meet with them weekly, give
them the gift of accountability.
This is where we were last week.
This is where we are this week.
These are the plans that wemade.
These are the problems weidentified.
(20:34):
What is the update?
What is the update?
This does not need to take morethan 30 minutes, but that 30
minutes will be at theequivalent of thousands and
thousands of dollars.
If you do it, and if you don't,everybody will forget it and go
to the status quo.
Everybody, including champions,need the gift of accountability
(20:55):
, right, and so you meet withthem weekly to at least you slow
down the bleeding, right?
Okay, so that's the thing Iwould do, absolutely Okay.
Number four I would hold thebiller.
So she has a biller, like herEHR company does the billing and
then she has another person toassist with the billing.
Okay, I would hold bothaccountable.
Okay, I will hold both of themaccountable, to whatever metrics
(21:16):
and all of those things.
I would even hold the frontdesk accountable.
If they're not verifyinginsurance eligibility,
collecting co-pays Like if yourpersonal AR as opposed to your
insurance AR is also really high, I will hold them accountable.
Like, all co-pays need to becollected.
All co-insurance needs to becollected.
All deductibles need to becollected, all balances need to
(21:37):
be collected.
I want you to start thinkingabout your front desk person as
your director of finance.
Their job is to collect money,because your practice is in a
place where you need like,everybody needs to collect money
, but for this practice inparticular, they need to collect
money.
They can leave no money on thetable none.
Okay, then number five islong-term.
(21:57):
You have to look.
Do I need to start looking fora new billing partner?
Do I need to look for newbillers?
Okay, because if you're workingwith billers and they're not
making the changes, they'regaslighting you.
It's the same thing over andover again.
They're not getting any senseof urgency or whatever.
You probably need to work withthem to do what you need to do
in the moment, but if you knowyou're going to look, then you
(22:19):
want to start looking, becausethat's a whole process on its
own.
And again, I would treadcarefully.
I would not roll over mybilling to a new company without
interviewing people who areusing that new biller and want
to go with hearing their realexperience, especially if
they're people who know whattheir numbers are.
Sometimes people are like, oh,that biller is great.
They've never met with them,they don't know what the AR is
and all that.
It doesn't matter.
(22:39):
So you want to talk to somebodywho, like you, is looking into
their numbers.
They know what it is, they knowtheir billers, are good at this
and all of that kind of stuff.
Okay, I would say, long-term,start looking for new billing
partners if you need to, okay.
And again, a financial trackingsystem like you know, practice
pilot is probably a good systemfor you to keep your numbers in
(23:00):
front of you.
You can see it as a simplesystem.
You can log in every day, seewhat we're doing with money,
let's see what our potentialrevenue is, look at what our AR
is looking like and all of thosethings, okay, okay.
So that was the second problem.
First problem reimbursement islow and slow.
Second problem AR is out ofcontrol.
Third problem high overhead.
Okay, now, I didn't get all thedetails of the overhead, but,
(23:20):
for instance, her rent is $9,500a month.
Right, that's $120,000 a year,almost, Okay, all right.
So we have high overhead in themidst of our low and slow
reimbursements, okay, and our ARbeing out of control.
So we have inflow problems andwe have outflow problems, okay.
So what would I recommend?
(23:42):
She does Right, so this is ahigh rent, it's a high lease and
, by extrapolation, our overheadis just high, okay.
So one is consider subleasing,and one of the things that
happens when we have really bigthings that we need to work
through is that our mind offersup this thought of it's not
possible, you can't, it's notpossible, nobody does all of
(24:04):
that stuff.
You're an entrepreneur now,right, so everyone watching this
, and so what that means isthere are very few things that
are, we don't start with,impossible.
So we don't say I can't do that.
We say how can I do that?
This is such an empowermentquestion.
How can I do that?
How can I pull that off?
How can that be possible?
How can?
Okay, so, have human beingssubleased?
(24:24):
Yes, yes, millions of peoplehave subleased.
So, okay, how can I?
Right, oh, but the landlordsaid I can't sublease.
Okay, does he want that?
Or does he want a privatepractice?
That's not there at all andcan't pay him money anyway?
I'm paying you 10 grand a month.
Man, help me figure out how tohelp you.
Okay, and so, yes, so can it benegotiated?
Yes, can we find a tenant?
(24:44):
Yes, we can.
We simply can.
Okay, all right.
So, especially if you're notusing all this space, oh, my
goodness, because you can reduceyour rent by $2,000 a month if
you can find somebody whosublease for $2,000 a month.
Okay, so that's a thing, and Iwould work it.
I would work it.
Okay, I would tell the peoplein my network, I would have my
team talk to people, I do allkinds of stuff, okay.
(25:05):
Second thing is reducenon-essential, non-revenue
generating expenses, and so whatthat means is you're going to
pull, for instance, your bankstatement, your credit card
statement, all of those thingsfor the practice, and you're
going to go line by line.
Okay, is this essential to therunning of this practice?
Does this create revenue?
(25:26):
Is this essential to therunning of the practice?
Does this create revenue?
Is this essential to therunning of the practice?
Does this create revenue?
Is this essential to therunning of the practice?
Does this create revenue?
And if it doesn't just chop itoff, chop it off, okay, and it's
a way of thinking.
I recommend this for peoplewhen their practices are booming
.
It's like you want to gothrough.
Does this essential?
Does this generate revenue?
Okay, now I want to tell youthree things to never cut off.
(25:50):
Okay, these are three things wedon't cut off because we need
them.
Number one advertising with areturn on investment.
Okay, so let's say you wererunning ads.
You were running Google ads orFacebook ads and whatever.
So let's say you're doingGoogle ads and from Google ads,
you get 40 new patients everysingle month and you're spending
(26:11):
a thousand dollars on it.
Okay, now let's just make upnumbers.
Let's say you know, for theirfirst visit their first visit is
just for the sake of math let'ssay it's $150.
Okay, so you have $150 times 40, right, that's $6,000.
So you are making an ROI returninvestment of $6,000 for every
(26:34):
$1,000 you spend.
Okay, so how much do you spendon that, all the money you can
spend, because it's paying foritself Every time you spend one,
you get six, which is a net offive.
You see what I'm saying.
So, when we're reducingexpenses, we don't cut that.
Now, if you have the marketingteam, you're paying 12 grand a
(26:54):
month and they're not doinganything, by all means cut them
Right.
Well, when you have anestablished, documented I can
see in the bank ROI you don'tcut it off.
You don't cut it off, okay.
The second thing you don't cutoff is coaching and consulting
with an ROI, okay.
So, for instance, in thisconversation that I'm having,
(27:16):
like, where we'retroubleshooting this private
practice, you will find thatthese strategies, if you execute
them, the minimum you'll beable to get from this one
conversation is a hundredthousand dollars, and this can
extend to multiple seven figuresdepending on how aggressively
you execute on these strategies.
Seven figures depending on howaggressively you execute on
(27:39):
these strategies, okay.
Now if you are paying somebodyright for this and you are
getting the strategies that arekeeping you in motion, you're
getting the strategies that arehelping you build, you don't cut
that off.
You don't cut that off right.
You don't why the ROI is hugeIf you can go from a failing
(28:00):
practice to a thriving practice,like a failing practice to a
profitable practice, to athriving practice through a
coaching program.
You don't cut it off, right,because the ROI is ginormous,
okay.
The third thing you're notgoing to cut off is you're not
going to cut off your team withan ROI.
(28:20):
So, let's say, your front deskperson.
You talk with them about thisnew strategy we're going to
engage and this person takes herrole as the director of finance
like super seriously and she'scollecting all the dollars and
every day she's collectingbetween $500 and $1,000 in
co-pays, old balances, all ofthese things.
And you're like, oh, my payrollis so high, I'm going to slash
(28:43):
my team.
You don't slash that personbecause their ROI is ginormous.
Do you see what I'm saying?
Now notice for each of them.
I said, with an ROI, if itdoesn't have a return on
investment, throw it away, butif it does, we don't cut that.
Okay, all right.
So your non-essential,non-revenue generating expenses,
(29:06):
you can get rid of those.
Okay, all right.
So the next thing we're goingto do for this really high
overhead is to increase revenue.
So we go back to what we hadwith number one.
I'm going to talk about more.
Right, we increase revenue.
Right, because there's someexpenses that just can't be cut.
So we go after making revenueso that our expense to the ratio
becomes a lot less.
Okay, and this is my favoritestrategy.
My favorite strategy is let'screate that.
(29:27):
Of course, we want to shed fatand get rid of waste.
We don't want to be wasteful.
We want to be good stewards butat the same time, good stewards
but at the same time, yourrevenue, this is your big
strategy.
Okay, all right.
So then the doctor had teamissues.
So she said I have three teammembers no office manager, not
(29:50):
there yet.
Two are rock stars, one is not.
Okay, I've had multipleconversations with this one with
her productivity, but shedoesn't know how to pivot.
Okay, so she might be what wecall a steady Eddie.
Steady Eddies are people whowill come, they will do the same
thing every single day, forever.
They're not going to beproactive, they're not going to
come up with some big, daring,great plan and all those things,
(30:10):
but they are steady Eddies.
And so, right off the back, Iwill say, like, if this person
is a steady Eddie, they do wellin the confines of this one
thing.
When I say one thing, I don'tmean one task, but I mean if you
tell them what to do, they'lldo it, but they're just not
going to be creative and they'renot going to do that.
Then you want to ask yourselfis this one I can repurpose?
I'll talk about that in asecond, so let me not get ahead
of myself.
Okay, so the team issues what'smy recommendation?
(30:32):
Okay, now I will start with myobservations, and this is my
observation after studyingthousands of private practices
over the years.
Okay, the number one problemwith most of the teams in
private practices is the teamleader.
Is the physician owner, like weare the problem of our team.
Right, and a lot of times thatproblem is because we don't
(30:55):
define what their role is.
We don't define what their roleis, we don't define how this
role makes money.
We don't have clarity on whatthey're supposed to do.
We have not communicated withthem how to win, so they don't
even know they're in abasketball game and they don't
know where the basket is and,like we're the issue.
Okay For the most part.
So that's an observation I made.
Another observation I made isthat you know.
(31:15):
So that's an observation I made.
Another observation I made isthat you know improperly led
teams are where practice profitsgo to die Because you're seeing
the patients, you're generatingthe revenue, but you haven't
empowered your team, so yourteam becomes dead weight, your
team becomes a liability, and sothey're not creating revenue,
so you are the only revenuegenerator, okay.
So once you stop everythingstopped, once you stop like you
(31:38):
have no support, you feel likeyou're carrying everything
yourself is too much, and I'mgoing to show you how to how to
fix that and so.
So that's where profits go todie, and we just didn't set up
our teams to help us.
To help us with the burden ofownership, with the burden of
creating revenue, right, okay,burden of ownership with the
burden of creating revenue,right, okay.
(31:59):
So what are my recommendationsas how to fix this?
Number one define KRAs, keyresult areas for each role, and
I didn't say key tasks, I saidkey result areas.
So, for instance, for a frontdesk person, we're not saying
well, greet the patients, checkthem in all of that stuff.
Those are activities, those aretasks and those do nothing.
Right, like, of course they'revery important, but oh, my
(32:21):
goodness, those are tasks asopposed to right, as opposed to,
for instance, 100% collectionon all co-pays, deductibles,
co-insurance and old balances.
Right, pays, deductibles,co-insurance and old balances,
(32:42):
right.
We say 100% insuranceverification on all appointments
, right.
We say five Google reviews aday, which means they have to
greet the patients in a certainway, do things in a certain way.
So when the patient is leaving,it's like I hope you had a
great experience.
It would be so much to me ifyou could leave me a five-star
review.
That's how I keep my job.
I'm not saying that's how shekeeps her job, I'm just being
(33:03):
funny.
But when you have theseoutcomes, now their creativity
is unlocked to go, make itpossible and you can show them
like.
This is the outcome.
These are the activities you doto get there.
But when you do that, can youimagine you don't have to bear
the weight of, oh, things werecollected upfront, or we're
getting reviews, or like, you'resharing, you're sharing it
(33:26):
right, okay.
So, and every role in the KRAs,every role, needs to include
serving and earning.
It has to include both.
Okay, all right.
So the second thing I would dois now distribute the outcomes
linked with turning the shiparound.
So we've talked about a lot ofthings.
We've talked about the billers.
(33:48):
We've talked about collectingour old balances, maximizing
daily production.
We've talked about auditing.
We've talked about all of thesethings.
You want to do it with yourteam.
Don't do it alone.
Don't do it alone.
So, for instance, we need tomake sure we're collecting all
the money for what we do.
So the front desk person couldhave collected all the upfront
(34:10):
money, right?
You can have another personthat's in charge of creating
three appointments with thiscash-based vertical that you
want to do.
Right, you have your billerwith the metrics, so they're in
charge of that.
Like, share the burden for thisstuff.
Maybe you looked at your dailyproductivity and you're like, oh
my goodness, like we're seeingfour patients less than I
(34:31):
actually want to see.
They have another person who'sin charge of making sure you see
X number of patients a day.
They're hitting the recaller,they're doing all the things.
But do you see what I'm saying?
Don't just bury it all.
Bury it with the team.
Cast vision with them.
Tell them this is the kind ofpractice we're in.
Tell them about all the privatepractices shutting down and
(34:54):
we've decided we're not going tobe a statistic but because we
can do the things right, shareit in such an inspiring way and
tell them let's go.
They will go with you, okay.
Third recommendation repurposeor de-hire team members as
needed, okay.
So, like the study, eddie, ifyou need to repurpose them where
they're doing something, wherethey're kind of doing the same
(35:14):
thing, and it's a thing thatneeds to be done, doesn't need
to be automated, and stuff likethat, you know, like you kind of
put them in that position.
If they just can't work likethey, hire them, and the sooner
the better, okay.
And again, this is one of thereasons why I like Practice
Pilot.
I think I'm going to keepmentioning it and you can check
it out.
It's practicepilotio.
But this is one of the reasonsI like Practice Pilot, because
(35:35):
it's self-reporting and youdon't want to enter the data.
You want your team to enter thedata, so they will see.
Our goal was to see this numberof patients, but today, oopsie,
this is what we saw, right.
And they're like, oh wait, weneed to fix that.
They're the ones who put in theAR.
They're like, oh, my goodness,and they see that right, and the
person and the insurance andall of those things.
(35:56):
So you want that, because whatit does is it helps your team
see what you see and it helpsthem come to the conclusions you
came to right.
Okay, all right.
So that was the fourth problem.
That was the fourth problem shetalked about.
The fifth problem she talkedabout was her personal finances.
Okay, so there's financialpressure there because she took
(36:16):
out a HELOC, she took out fromher 401k, she got a bank loan
and she used this forrenovations, equipment,
furniture, personal bills, andshe has personal bills still and
stuff like that.
Okay, so what is therecommendation here?
Okay, now, first of all, I willsay this If I was talking to
this person face-to-face, Iwould say you want to be careful
.
If I was talking to this personface to face, I would say you
(36:38):
want to be careful?
Okay, because financialpressure is real.
Financial pressure is hard andit is sometimes really, really
hard to make smart financialdecisions when the pressure
shows up.
Sometimes it's really hard.
Money led decisions like I'mmaking this because of financial
pressure are rarely ever theright ones, and I say this like
I'm almost sending I'm sendingvirtual hugs first.
I know this is hard and all ofthat stuff, but let's walk
(37:01):
through some things to do.
Okay, all right Now, and partof being careful is probably if
you feel under so much pressure,you feel I must make a decision
now.
Now, I must do this now, now,now, now, now, probably decide
to sleep over it when you're inthat state.
Don't make any decisions.
Don't make any decisions, okay,so, so that's the first thing.
(37:21):
Just be careful.
Second thing aggregate all yourdebt, okay.
So, these are all the things Iowe.
This is how much it is.
This is what all the monthlypayments come up to.
This is what the total monthlypayment comes up to.
And talk to all your lenders.
Everything is negotiable.
Everything is negotiable.
So if there could be a pause ofsomething without increasing
(37:45):
your interest rate, that wouldbe awesome.
If there could be a decreasedinterest rate, if they're
willing to do that, that wouldbe awesome.
Talk with them.
If they would do lower paymentsfor X amount of period, again
without changing the interestand changing the terms we don't
want to go from one issue toanother then that would be
awesome.
But don't make the assumptionthat it's not negotiable.
(38:07):
Everything is negotiable.
Everything is negotiable, okay.
Number three I said this before, but I'm going to say it again
prioritize services thatincrease cash flow.
Okay, prioritize services thatincrease cash flow, because we
want cash flow coming in.
The thing that will give youthe greatest peace, right with
this, is bringing in revenuethat makes up for that.
(38:29):
Okay, all right.
And one of the things was youknow, do I sell my house or do I
not sell my house?
I would say it depends on youreally want to think about that.
For instance, if you're like Iwas looking to sell in the next
one to two years anyway, and youhad a home that has so much
equity in it, it had a lowinterest rate, all of that stuff
, and you'll be able to sellthis, buy what it is you want
(38:52):
now, and then you have profitsoff of that that you can put
into whatever you want to.
You can do that.
If you're not thinking aboutselling it at all, and maybe you
got a house in the last twoyears and all of that stuff and
it's just going to be a lose,lose, lose, then you want to
think maybe of not doing that.
But what I will tell you isthere are multiple loans here
(39:12):
and you don't have multiplehouses to sell, right?
And so you kind of want tothink of what would I do to get
myself out of this, outside ofthe house, and then say, okay,
do I want to go all in on doingthat and then keep my house.
You see what I'm saying.
So there's a lot of thinkingthat needs to go into that.
But I would say no hurry to dosomething that is fairly
(39:37):
permanent off of something thatis temporary.
Does that make sense?
So that's the way.
But there's more, there's a lotmore conversation.
So I would say you want to bestrategic with what you do here?
Okay, but definitely talk toyour lenders for sure, for sure
and for sure.
Get that cashflow engine going,bringing revenue in and all of
(39:58):
those things.
Okay.
So lots of stuff.
And so this is the last one andit's mental exhaustion from all
of this.
Okay, and I'm going to readwhat this doctor said.
I think it's important becausethis is what she says.
I'm a solo doc.
I've always done it alone.
I haven't had mentors orphysician colleagues to bounce
ideas off.
(40:18):
I feel isolated.
I'm a black female physician intown with only two to four
other black females in privatepractice, but there are 30 to 40
doctors in my specialty in thistown and all that stuff.
I'm losing hope.
Okay.
So again, first of all,specialty in this town and all
that stuff.
I'm losing hope, okay.
So again.
First of all, long.
You know the long squishy huglike long, squishy, big,
(40:40):
understanding hug and all ofthat.
And I do want to say, you know,thank you so much for what you
do, because you've chosen toserve people for this long.
You've chosen to build your ownhealthcare system, which is
really what we do as privatepractice owners, and think of
what thousands of people whowould not have access to great
care if you didn't say yes todoing what you do.
(41:01):
So big, big, big hug.
And I want to say theprinciples of rest.
Sometimes it's really hard withwhat you're going through, but
there's rest, there's meditation, but there's also a support
system and I want you tounderstand that, no matter what
it's out there, you can have asupport system.
(41:24):
It may look different, you mayneed to get a little creative
right.
Some of them may be outside ofyour area and some of them may
not even be close to you.
They may be online.
I have such great relationshipswith some doctors who've poured
into me so much and who I'vebeen able to bounce ideas off
and all of that, and I haven'teven met them in person.
(41:44):
Some of them I met them inperson after three years.
You know what I'm saying and soI don't want you to accept this
, the fact that you can't have agreat support system.
I want you to know that youdeserve a great support system
and then build it.
They may not all be in yourarea, they may not all be like
you, they may be online and allof that stuff Just refuse to
walk alone, right?
(42:05):
And so what is a good startingpoint?
In the communities where you dofind yourself, show up, ask
questions, talk to people,schedule lunch dates, schedule
Zoom meets, zoom meet and greets, have conversations, start
networking and you find yourpeople, or people who know your
people, and all of that stuff.
Right, I will start, but I willstart from this thing that of
(42:26):
course my support system is outthere and of course I deserve a
great support system.
And no, I am no longer going towalk alone.
I'm just not going to do itright and know I am no longer
going to walk alone, like I'mjust not going to do it right.
And so, whether there's spacesonline, you know, if we have a
number of communities, we havethe Profitable Private Practice
Movement, like if you're part ofthat, like when you come in
(42:46):
there, show up, show up in thecomments, connect with people
and then take thoserelationships offline and stuff
like that.
Like, do that.
The Entre Ambi Business Schoolis another one, huge
relationships offline and stufflike that.
Do that.
The EntreMD Business School isanother one, huge, huge, huge
one.
Right, and build your owncommunity.
And in a time where most peopletalk about private practice
being dead and you can surviveand woe is us and all of those
things find people who aresaying the opposite.
(43:07):
Find people who, like you, wantto take their practices from
not doing really well to reallyreally profitable, to thriving.
Right.
So do that, right.
So show up in those spaces andstart building those
relationships.
Okay, set a target for yourselfthree, then six, then 12, then
whatever and build that foryourself, okay.
(43:28):
And then you know so good, well, it always comes back.
You know what I mean.
And so when you have anopportunity to help somebody and
when I say help, I don't wantto mean like you shut down your
office for a day and go do stuff.
I'm not even talking about that.
I'm talking about simple thingslike somebody opened a new
practice and you're mailing thema card and saying, oh my
goodness, congratulations,welcome to the area.
(43:48):
Somebody gets an award.
You like, congratulate themSomebody.
It seems like they'restruggling, you encourage them
and stuff.
It's goodwill, and the thingabout goodwill is it's going to
come back to you.
It may not come back from theperson you showed goodwill
towards, but it will come backfrom somebody, right?
And so do that.
Do it knowing that I'm justsowing these seeds and they're
going to come back to me, butrefuse to walk alone.
(44:11):
And if you look in your circle,your network, your area, you'll
find that there are people Ican show goodwill into and there
are people that I can starthaving conversations with and
start building that supportsystem, right, whether they're
online or they're in person andstuff like that.
And so I know we went through alot of stuff, but I hope out of
(44:31):
this you can build out likethis is where I'm going to start
from and revenue you reallywant to to start, you want to
really want to start with fixingthe revenue and all of those
things.
But you have things that youcan say okay, these are the
seven strategic things I'm goingto do over the next 30 days
with my team.
So, with your team, you can doseven right, like I'm going to
do over the next 30 days to putmy practice in a position where
(44:54):
we can start the process ofthriving right.
And these are the things youcan map out.
And if you have questions, youknow for everyone who's watching
the comments and all of thosethings like post them in the
comments.
I will come back.
I may make a whole video on allof those things, but for this
doctor, I want you to know thatI am rooting for you.
I believe in you.
Obviously I support you.
(45:15):
I that I am rooting for you.
I believe in you.
Obviously I support you.
I guess I'm one of yoursupporters, right?
I support you and I reallycannot wait to hear about you
turning this around.
I know that, yes, it's going tobe challenging.
It may even get a little harderbefore it gets easier, but I
know you can do it and I knowyou have the strategy and I'm
rooting for you.
Stay connected to us, whetheryou're in PPPM or you're reading
(45:38):
the Profitable Private PracticePlaybook, and we have so many
resources.
If you have questions, justpost them in the comments.
I'll come back for it.
Okay, now I want to challengeeveryone to take the link of
this video watcher.
If you're listening on thepodcast, I want you to take the
link and share it with everyprivate practice owner you need,
because these are strategiesthat work, whether your practice
is struggling, or your practiceis profitable, or your practice
(46:02):
is thriving right Like theseare the things we want to stay
on top of.
So we continue to thrive,because the more we thrive, the
better it is for our patients,the more empowered physicians we
have, and then we now have agroup of people who can go into
the healthcare system and turneverything right side up.
Okay, all right.
So absolutely rooting for youand I'll see you on the next
(46:23):
episode.
Hi docs, Welcome to the EntreMD podcast, where it's
all about helping amazingphysicians just like you embrace
entrepreneurship so you canhave the freedom to live life
and practice medicine on yourterms.
I'm your host, Dr Imna.
We have a doctor in privatepractice who has a practice
(00:23):
where her overhead is so high,her revenue is a lot less and
she thinks that her privatepractice is at risk of failing.
Speaker 2 (00:31):
And so today, what we're going to do is take a look
at this practice, come up witha diagnosis, fix the practice
and give this doctor a strategyshe can start working with and,
right away, start seeing wins inher practice and, over time,
bring it from a place where itgoes from almost failing to
completely thriving.
Okay, so we're going to look atthis private practice.
This is going to be a lot offun If we haven't met before.
(00:53):
My name is Dr Una.
I'm a pediatrician by training.
I have been in private practicefor the last 15 years and at
this point I've technicallyexited my practice, if you will.
My practice is team-led andit's been that way for the last
five years.
And then I'm the founder ofEntreeMD.
I help doctors build profitablebusinesses so they have the
freedom to live life andpractice medicine on their terms
(01:14):
.
I am a huge advocate forprivate practice.
Private practice is not dead.
The old playbooks are and, yes,we have a lot of systemic
problems in the healthcare space.
But until we have enoughempowered physicians who can
then stand up to the system, weare going nowhere.
Okay, so I fully understandthere's a lot of things to fix,
but you know, when you get on aplane, they tell you, if the
(01:34):
pressure goes low, oxygen masksare going to come down.
You're going to put it onyourself first and then you're
going to put it on others, okay,so this is us putting the
oxygen mask on ourselves, okay,all right.
So when this doctor told me this, I said okay, I want you to
think about the top five thingsthat are creating this financial
pressure and financialchallenge you have in your
(01:56):
private practice.
And she sent me these fivethings, so we're going to
troubleshoot these five things,okay.
So the first thing was you knowmy reimbursement right from the
insurance company.
So this is insurance-based.
Private practice is low andslow.
Okay, so it's low and slow.
Money coming in, and we knowmoney coming in.
That's like the blood, if youwill, of the private practice
(02:18):
and all of those things.
So this is something that weabsolutely need to fix, okay.
So she gave me some context.
She said there's a largediscrepancy between insurance
carriers, and so you know.
So some pay you know well andsome pay very poorly.
She said I've already stoppedtaking Medicaid.
There are thousands ofoutstanding dollars after the
(02:38):
first year with Medicaid, andthen it's considered letting go
of TRICARE.
Okay, and again, because of lowreimbursements and all of those
things, and so this issomething that absolutely needs
to be fixed.
When you think about thepractice revenue, anything
touching it is like somethingtouching your aorta, like once
(02:59):
you bleed from there you'rebleeding out, right.
So this is something veryserious.
We want to look into it and wewant to fix it.
So I came up with somerecommendations for her.
Okay, these are things that shecan consider.
These are things that she cando.
Some of them will work fairlyquickly.
Some of them will work overtime.
I don't think that any of thesestrategies really that she
shouldn't employ.
(03:19):
Okay, so the first one I said islooking into joining a network
that manages contracting.
Okay, so, like an IPA, anindependent physician
association, or PHO, a physicianhospital organization, you know
, like one of these, and this isif she's not already a part of
it.
And why is that?
Well, because theseorganizations have a pool of
(03:41):
physicians within them.
They're usually able tonegotiate for better rates.
Okay, so there's so many peoplewho have had significant bumps
in their revenue just becausethey went from contracting
directly to contracting with anIPA right Now.
So if she hasn't done this,this will be a really great
thing to consider.
Chances are that it's not goingto bring an immediate
(04:02):
turnaround, because it's goingto be a process to go through
them and all of those kinds ofthings, but it's something that,
yes, it will bring a lot oftransformation.
Now I will say with this,because it has to do with your
money and the entire revenue ofyour practice, you do want to
choose carefully, right,everybody's going to sell you a
good game.
They're going to say, when youcome on, we'll do this, we'll do
(04:23):
that, blah, blah, blah.
They'll make all the promisesin the world and I'm going to
challenge you to find three tofive people who are using that
IP or using that PHO and go findout from them what the real
deal is.
Right, so you want to getreferences.
It doesn't have to be from thecompany.
It can be from the company orthe organization, or you can get
them directly like who's partof this network, who's part of
(04:44):
this network?
And you go interview and havereal conversations.
Okay, do not take anything atface value.
This is something that we do asphysicians and something we
want to walk away from doing.
Okay, something we want to walkaway from doing, which is,
whatever they said, we justbelieve them, don't.
You're an entrepreneur now.
That's not what we do.
Trust, but verify, right.
Okay.
So that's the firstrecommendation for reimbursement
(05:07):
being low and slow.
The second one is to audit thedistribution of patients and
insurance in the practice.
Data is a very beautiful thingbecause data will show you like
data preaches to you.
You see, the data automaticallybecomes obvious what needs to
happen, right.
And so you want to think likewhat are the top three
(05:30):
insurances my patients use?
You want to know what thatnumber is.
You want to know what thoseinsurance companies are.
You want to have a feel for it.
But, more importantly, you wantto know, like, based on the fee
scale, you want to organizethem from best paying to lowest
paying, right.
And then you ask yourself aquestion for the lowest paying
ones Am I even making money onthem, or is every?
(05:52):
Do I lose money with everyvisit Because we've had to drop
some insurances because theywould pay us lower?
Or the exact amounts that thevaccines cost?
And I'm like, if you pay me theexact amount that the vaccines
cost, I am losing money witheach vaccine I give because I
have to buy the vaccine, I haveto store the vaccine, I have to
pay staff to process the vaccine, I have to do all of these
(06:14):
things and so, yeah, and we havevaccine wastage.
I'm losing money on that.
And so you are an insurancecompany that is too expensive
for me to be in network with,like you're too expensive
because you cost me money, right.
And so you have to look like,am I losing money?
Or I'm just not getting as much?
Like, what is it right?
(06:34):
If you know like, and then youwant to consider dropping some.
If you need to drop them, right, if you need to drop them
because it's a business decision.
But you want to look and thenyou find out that most of your
patients are with a very poorpaying insurance company, then
the question then becomes do Iclose the panel and market
(06:55):
really hard and change thedistribution?
Now, this doesn't mean changethe philosophy of your practice.
For instance, my privatepractice is 60%, is about 60%
Medicaid, and at a point it waseven higher.
And I'm okay with it becausethat's what I wanted.
I, you know, I wanted apractice where I could people
who had really good insuranceand people who had Medicaid they
(07:16):
, you know, they could come,they get treated really well,
they have a great experience.
They have access to a doctor.
We had same day appointments,we had like all kinds of fun
stuff.
I wanted them to have that.
Now, what it means is I was alsoaware that I was playing a
volume game.
I, you know, like I didn't lieto myself.
You can't say I want to takeMedicaid and I want to see one
patient an hour.
Those two things cannot coexist.
(07:37):
The business will die.
It will die a sure death, right.
And so I'm like okay, I want todo that.
So the question then becomeshow can I go through the volume
and do it in such a way thatit's still a very personalized
experience where they felt likethey were heard and all of that?
Then I had to come up with thestrategies for people to have a
great experience, even thoughthen I'm not sitting with them
(08:00):
for an hour.
Do you see what I'm saying Like?
So it doesn't mean find thepeople, drop everybody.
That's not what it means.
But if you don't have the data,you don't know.
So I have 10,000 patients,wonderful Top three insurance
companies used by those 10,000patients.
You want to know what that is.
Then you want to have theinsurance companies top to
bottom, from best paying tolowest paying and lowest paying
(08:22):
is it lowest paying, like I'mmaking a little profit, or is it
lowest pain, like I'm losingmoney?
If you're losing money, you gotto drop them.
You got to drop them.
Okay, all right.
So that's the second thing wewant to do, this audit of the
distribution.
The third thing for this person,because her specialty lends to
it, is I'm like, but you want toconsider some cash-based
(08:43):
services and chances are, thisdoctor has either been thinking
of it or maybe has somecash-based services, but they
haven't necessarily beenpromoted and stuff like that.
And the reason why I broughtthis up because, with what this
practice is going through, itdoes seem like having an
immediate cash injection wouldbe really good for the practice,
(09:05):
and so if they're cash-basedverticals that already exist, we
want to go hard on those.
If they don't exist I mean forthis person's specialty there
are many that can just exist.
They can start today becausethis person is equipped to do
them.
They're hot topics, all ofthose things, so they can do
them.
Why Immediate cash flow andhigher margins?
Right, because you don't needthe bill or you don't need this.
(09:27):
There are a lot of things thatyou don't need, so I would do
that because and someone may say, oh, but this is so businessy,
we're just going to bring theseservices because of the cash.
No, we're going to bring theservices because it'd be high
value to her people and it willbring cash.
And if you're in privatepractice, I don't want you to
continue to be thrown off by theneed to make money, because for
(09:48):
your practice to stay open, youneed to make money.
We need to stop pretending, weneed to stop acting like this is
not an important thing.
I am fully aware that one ofthe best ways I serve my
patients is by stayingprofitable, because if I'm not
profitable, I have to go away.
Okay, okay, so that's that's.
The third recommendation is tolean into some cash-based
services.
Okay, again, cash injection,because this practice, we need
(10:10):
to get cash in.
The fourth thing is I wouldprioritize services that
increase the cashflow, and I'llexplain what I mean by that.
Okay, so let's say, forinstance, in my private practice
, if we say, oh, it looks likethe next two weeks that we have
(10:30):
open spots and stuff and we needto do something to fill our
schedule, so we need to beproactive as opposed to reactive
.
Okay, and I have.
Let's say, I have 300 patientswho are overdue for well checks.
Okay, now I know that I can'tsee all 300.
So what are we going to do?
We are going to call the peoplewith the better paying
(10:52):
insurance and we're going to getthem in.
What is that going to do?
It's going to give me a bettercash flow.
Now, you might say, but what ofall the other people?
Well, in my practice, we happento have a routine schedule for
sending out reminders to makeappointments.
So they have all had reminders,every last one of them.
Okay, we also do not let peopleleave the office without
(11:13):
scheduling appointments.
So for them not to have anappointment, it means that they
canceled the appointment or theyno-showed for an appointment
and we have not been able toreach them.
Okay, so are we reaching out toeverybody?
We are, but if I want to gohard and put staff time behind
bringing people in, I am goingto leverage what will be a
bigger win-win situation for allof us.
Okay, all right.
(11:34):
So for this doctor, you have tobe aware.
You have to be aware.
The services that I offer, topto bottom, from biggest revenue
generator to least revenuegenerator, do you do all of them
, sure, but in a situation likethis, where we're like, oh, my
goodness, something needs togive, you want to prioritize
(11:55):
those.
You're available for everything, but you prioritize those, okay
, all right Again, if this makesyou feel like, but it's about
the patient, of course it'sabout the patient.
That means you're treatingpeople differently.
No, no, no, no, we're not,we're not.
But seeing patients is theresponsible thing for a doctor
to do, and keeping the practiceprofitable is a responsible
(12:18):
thing for a doctor to do.
They're both responsible things.
So we're doing both.
Okay, all right.
The fifth recommendation thereI have is maximize daily
productivity.
Now, this is so, so, so, soimportant.
Okay, I will give an example.
I was talking to a doctor,someone that I really have a lot
(12:40):
of respect for, and all of thatstuff.
She's running a practice, shebuilt it from scratch, she's
doing an amazing job.
And then, while we were talking, she says you know, I don't
want to get burned out.
I want to see a certain numberof patients every day, you know,
because that's what I want tosee.
Okay, and then I said so.
(13:00):
And then she went on and I saidwait, wait, what is that number
?
How many patients do you wantto see and I asked this question
because I know she's aninsurance based model and so she
says I want to see 14 patientsa day.
(13:25):
No, your reimbursement isprobably not more than $150 per
visit.
So I'm like, okay, we're goingto do some math here.
Okay, so 150, I didn't use 150,I used 100 on that day because
the math was easier.
But let's do the real math.
Okay, 150 times 14 is 2100.
So I mean that your cap withyou as the doc there, your cap
is 2100 a day.
Okay, and you multiply that by260, you're at $546,000.
(13:47):
Now when I did the math with100, it was $364,000,.
Okay, so you're at $546,000before overhead.
That's the cap.
If your practice is like 60%overhead, which is not unusual,
(14:08):
your 60% overhead puts you at327,600.
So the question is then becomeswhat's left?
Right, what's left?
So this is what we need to lookat.
You have to know what thenumbers say.
You have to know what thenumbers say.
So when I did it with her anddid the math at a hundred, I
(14:28):
said you're at $364,000.
That's the cap.
That's the most your practicecan bring in before overhead.
Before paying you before anyprofit, you have to be sure that
you're okay with that number.
You see what I'm saying.
So for this doctor, I wouldactually have her look like look
back on the last two weeks onthe last month.
How many patients are youseeing every day?
Look back on the last two weekson the last month.
(14:51):
How many patients are youseeing every day?
What is the maximum amount ofrevenue you can create with that
?
Are you having more no-showsthan you thought?
Are you seeing less volume thanyou thought?
With the volume that you areseeing, what is the max per day?
Because if that max per day isa number that you don't want,
something needs to give.
Do you see what I'm saying?
If we don't do the math, badthings happen, okay.
(15:13):
So this is part of the reasonwhy we use in my private
practice, we use Practice Pilot,okay.
So Practice Pilot is a financialtracking software for private
practices and when you create,when you go in there, one of the
things you would do is it willhave you put your average
reimbursement per patient, okay,and then you create, when you
go in there, one of the thingsit would do is it will have you
put your average reimbursementper patient, okay, and then you
will set what your goal is.
(15:34):
So if you say my revenue goalfor this year is I want to bring
in 2 million, now, based onyour average reimbursement per
patient, it will tell you howmany patients you need to see.
And if you say, no, I don'twant to see that number, I want
to see this number, it will showyou how much revenue you can
generate.
And once you see those, there'sjust something about seeing the
(15:56):
data that lets you know like,wait, I don't like that number.
And then, if you don't like thenumber, the average
reimbursement needs to change orthe volume of patients needs to
something, something needs togive.
Okay, so I would have thisdoctor do the math with the way
you're functioning, what is thepotential amount of revenue your
practice can bring in every day?
This is a number you want toknow.
Okay, all right.
(16:17):
So that was the first thing.
That was the first thing.
My reimbursements were low andslow, okay.
Second thing my AR is out ofcontrol.
Okay, my AR is out of control.
So when we looked at this, okay, this was the number, this is
the number that she gave me.
Okay, she said over over 90days.
(16:40):
So from from over 60 days wasalmost 80% of her revenue.
90 to 120 days was 38% of herrevenue.
She has a lot of revenuesitting in her AR, a lot of it
and for older practices you mayhave that because maybe you have
(17:01):
bad debt from years and yearsand years.
So you're over 120 is bloated.
She's in her second year.
She's in her second year ofpractice, right, and so to have
that number, I would definitelymake the assumption that my
biller is not doing a good job.
You can even make theassumption that maybe your fund
desk people are not doing a goodjob, maybe the insurance
(17:23):
eligibility, I don't know.
But there are things thatyou're going to.
Okay, we need to look here Now.
So these are therecommendations I have based on
that.
First of all, I'm like you haveto treat this as a matter of
urgency and I would think of itlike somebody's bleeding out.
You're a surgeon, you havesomebody on the operating table
and this person is bleeding out.
(17:44):
Nobody's like calm andcollected and whatever.
Like we have something to fix.
Okay, so we're not frazzled,but there's urgency.
Okay.
When you have AR like this thisearly in the game, there's
urgency.
This needs to be fixed.
It means the practice isbleeding out.
What that means is you know wehave this thing of if we're
(18:04):
seeing a lot of patients, thatmeans you know if we're really
busy, it means the practice isworking.
No, no, no.
The evidence of the practiceworking is in the bank account,
because the fact that you saw apatient doesn't mean you got
paid for seeing the patient.
It doesn't mean that at all.
After seeing the patient, thereare processes that need to
happen before you get paid.
So this is what I have for herTreat this as a matter of
(18:25):
urgency.
Treat it like there's somebodyin the OR on the table bleeding
out.
If you know the level ofurgency you have with that,
you're still calm because youhave the strategy.
You know the algorithms and allof those things, but it's
urgent, it's urgent.
So one is treat it as a matterof urgency.
Two is meet with the billers todiagnose the issue and create a
strategic path forward.
What that means is you're noteven offering all the things
(18:47):
when you have a vendor.
Please understand that thevendor works for you.
Okay, they may not be your W-2employee, but they work for you.
And so you sit with them andyou're like okay, we have an
issue.
Okay, this is what our billinglooks like.
This is what the nationalstandard benchmarks are.
So somebody walk me throughwhat exactly is going on Like,
what is the core issue here?
Okay, the core issue here?
(19:10):
Okay, it can be more than three.
What are the top three?
What are the three core issueshere?
Or the one core issue here isusually not one, so let's say
three.
And what is the strategic pathto move forward?
How do we make this AR looklike this AR, like this national
benchmark?
Okay, now, billers have beenknown to blow hot air because
they know physicians don't careabout this stuff, physicians
don't want to look at this stuff, physicians will not ask
(19:31):
questions.
I literally had a client whotalked to her biller like I want
us to meet and do all this, andshe's like no physician's ever
asked to meet with me.
I was like, ooh, we're in theon-term deal world.
Of course.
We ask this is the era of thepractice, right?
Okay, so what is the issue?
And when they tell youhighfalutin things, you're like,
break it down, break it down.
(19:51):
Like I'm a doctor, like I'm athird grader, like make it make
sense, but don't just acceptanything, right, don't just
accept anything.
The diagnosis needs to makesense to you.
The strategic path forwardneeds to make sense to you, okay
, so have them come up with it.
Create a strategic path forward.
You want to lean into it?
So I've taught about this inthe profitable private practice
(20:13):
movement, like you know how tolook at these things at all.
You want to look at it?
Okay, all right.
Then the third thing is afteryou're done with that meeting,
things will change.
If you do this thing, which isto meet with them weekly, give
them the gift of accountability.
This is where we were last week.
This is where we are this week.
These are the plans that wemade.
These are the problems weidentified.
(20:34):
What is the update?
What is the update?
This does not need to take morethan 30 minutes, but that 30
minutes will be at theequivalent of thousands and
thousands of dollars.
If you do it, and if you don't,everybody will forget it and go
to the status quo.
Everybody, including champions,need the gift of accountability
(20:55):
, right, and so you meet withthem weekly to at least you slow
down the bleeding, right?
Okay, so that's the thing Iwould do, absolutely Okay.
Number four I would hold thebiller.
So she has a biller, like herEHR company does the billing and
then she has another person toassist with the billing.
Okay, I would hold bothaccountable.
Okay, I will hold both of themaccountable, to whatever metrics
(21:16):
and all of those things.
I would even hold the frontdesk accountable.
If they're not verifyinginsurance eligibility,
collecting co-pays Like if yourpersonal AR as opposed to your
insurance AR is also really high, I will hold them accountable.
Like, all co-pays need to becollected.
All co-insurance needs to becollected.
All deductibles need to becollected, all balances need to
(21:37):
be collected.
I want you to start thinkingabout your front desk person as
your director of finance.
Their job is to collect money,because your practice is in a
place where you need like,everybody needs to collect money
, but for this practice inparticular, they need to collect
money.
They can leave no money on thetable none.
Okay, then number five islong-term.
(21:57):
You have to look.
Do I need to start looking fora new billing partner?
Do I need to look for newbillers?
Okay, because if you're workingwith billers and they're not
making the changes, they'regaslighting you.
It's the same thing over andover again.
They're not getting any senseof urgency or whatever.
You probably need to work withthem to do what you need to do
in the moment, but if you knowyou're going to look, then you
(22:19):
want to start looking, becausethat's a whole process on its
own.
And again, I would treadcarefully.
I would not roll over mybilling to a new company without
interviewing people who areusing that new biller and want
to go with hearing their realexperience, especially if
they're people who know whattheir numbers are.
Sometimes people are like, oh,that biller is great.
They've never met with them,they don't know what the AR is
and all that.
It doesn't matter.
(22:39):
So you want to talk to somebodywho, like you, is looking into
their numbers.
They know what it is, they knowtheir billers, are good at this
and all of that kind of stuff.
Okay, I would say, long-term,start looking for new billing
partners if you need to, okay.
And again, a financial trackingsystem like you know, practice
pilot is probably a good systemfor you to keep your numbers in
(23:00):
front of you.
You can see it as a simplesystem.
You can log in every day, seewhat we're doing with money,
let's see what our potentialrevenue is, look at what our AR
is looking like and all of thosethings, okay, okay.
So that was the second problem.
First problem reimbursement islow and slow.
Second problem AR is out ofcontrol.
Third problem high overhead.
Okay, now, I didn't get all thedetails of the overhead, but,
(23:20):
for instance, her rent is $9,500a month.
Right, that's $120,000 a year,almost, Okay, all right.
So we have high overhead in themidst of our low and slow
reimbursements, okay, and our ARbeing out of control.
So we have inflow problems andwe have outflow problems, okay.
So what would I recommend?
(23:42):
She does Right, so this is ahigh rent, it's a high lease and
, by extrapolation, our overheadis just high, okay.
So one is consider subleasing,and one of the things that
happens when we have really bigthings that we need to work
through is that our mind offersup this thought of it's not
possible, you can't, it's notpossible, nobody does all of
(24:04):
that stuff.
You're an entrepreneur now,right, so everyone watching this
, and so what that means isthere are very few things that
are, we don't start with,impossible.
So we don't say I can't do that.
We say how can I do that?
This is such an empowermentquestion.
How can I do that?
How can I pull that off?
How can that be possible?
How can?
Okay, so, have human beingssubleased?
(24:24):
Yes, yes, millions of peoplehave subleased.
So, okay, how can I?
Right, oh, but the landlordsaid I can't sublease.
Okay, does he want that?
Or does he want a privatepractice?
That's not there at all andcan't pay him money anyway?
I'm paying you 10 grand a month.
Man, help me figure out how tohelp you.
Okay, and so, yes, so can it benegotiated?
Yes, can we find a tenant?
(24:44):
Yes, we can.
We simply can.
Okay, all right.
So, especially if you're notusing all this space, oh, my
goodness, because you can reduceyour rent by $2,000 a month if
you can find somebody whosublease for $2,000 a month.
Okay, so that's a thing, and Iwould work it.
I would work it.
Okay, I would tell the peoplein my network, I would have my
team talk to people, I do allkinds of stuff, okay.
(25:05):
Second thing is reducenon-essential, non-revenue
generating expenses, and so whatthat means is you're going to
pull, for instance, your bankstatement, your credit card
statement, all of those thingsfor the practice, and you're
going to go line by line.
Okay, is this essential to therunning of this practice?
Does this create revenue?
(25:26):
Is this essential to therunning of the practice?
Does this create revenue?
Is this essential to therunning of the practice?
Does this create revenue?
Is this essential to therunning of the practice?
Does this create revenue?
And if it doesn't just chop itoff, chop it off, okay, and it's
a way of thinking.
I recommend this for peoplewhen their practices are booming
.
It's like you want to gothrough.
Does this essential?
Does this generate revenue?
Okay, now I want to tell youthree things to never cut off.
(25:50):
Okay, these are three things wedon't cut off because we need
them.
Number one advertising with areturn on investment.
Okay, so let's say you wererunning ads.
You were running Google ads orFacebook ads and whatever.
So let's say you're doingGoogle ads and from Google ads,
you get 40 new patients everysingle month and you're spending
(26:11):
a thousand dollars on it.
Okay, now let's just make upnumbers.
Let's say you know, for theirfirst visit their first visit is
just for the sake of math let'ssay it's $150.
Okay, so you have $150 times 40, right, that's $6,000.
So you are making an ROI returninvestment of $6,000 for every
(26:34):
$1,000 you spend.
Okay, so how much do you spendon that, all the money you can
spend, because it's paying foritself Every time you spend one,
you get six, which is a net offive.
You see what I'm saying.
So, when we're reducingexpenses, we don't cut that.
Now, if you have the marketingteam, you're paying 12 grand a
(26:54):
month and they're not doinganything, by all means cut them
Right.
Well, when you have anestablished, documented I can
see in the bank ROI you don'tcut it off.
You don't cut it off, okay.
The second thing you don't cutoff is coaching and consulting
with an ROI, okay.
So, for instance, in thisconversation that I'm having,
(27:16):
like, where we'retroubleshooting this private
practice, you will find thatthese strategies, if you execute
them, the minimum you'll beable to get from this one
conversation is a hundredthousand dollars, and this can
extend to multiple seven figuresdepending on how aggressively
you execute on these strategies.
Seven figures depending on howaggressively you execute on
(27:39):
these strategies, okay.
Now if you are paying somebodyright for this and you are
getting the strategies that arekeeping you in motion, you're
getting the strategies that arehelping you build, you don't cut
that off.
You don't cut that off right.
You don't why the ROI is hugeIf you can go from a failing
(28:00):
practice to a thriving practice,like a failing practice to a
profitable practice, to athriving practice through a
coaching program.
You don't cut it off, right,because the ROI is ginormous,
okay.
The third thing you're notgoing to cut off is you're not
going to cut off your team withan ROI.
(28:20):
So, let's say, your front deskperson.
You talk with them about thisnew strategy we're going to
engage and this person takes herrole as the director of finance
like super seriously and she'scollecting all the dollars and
every day she's collectingbetween $500 and $1,000 in
co-pays, old balances, all ofthese things.
And you're like, oh, my payrollis so high, I'm going to slash
(28:43):
my team.
You don't slash that personbecause their ROI is ginormous.
Do you see what I'm saying?
Now notice for each of them.
I said, with an ROI, if itdoesn't have a return on
investment, throw it away, butif it does, we don't cut that.
Okay, all right.
So your non-essential,non-revenue generating expenses,
(29:06):
you can get rid of those.
Okay, all right.
So the next thing we're goingto do for this really high
overhead is to increase revenue.
So we go back to what we hadwith number one.
I'm going to talk about more.
Right, we increase revenue.
Right, because there's someexpenses that just can't be cut.
So we go after making revenueso that our expense to the ratio
becomes a lot less.
Okay, and this is my favoritestrategy.
My favorite strategy is let'screate that.
(29:27):
Of course, we want to shed fatand get rid of waste.
We don't want to be wasteful.
We want to be good stewards butat the same time, good stewards
but at the same time, yourrevenue, this is your big
strategy.
Okay, all right.
So then the doctor had teamissues.
So she said I have three teammembers no office manager, not
(29:50):
there yet.
Two are rock stars, one is not.
Okay, I've had multipleconversations with this one with
her productivity, but shedoesn't know how to pivot.
Okay, so she might be what wecall a steady Eddie.
Steady Eddies are people whowill come, they will do the same
thing every single day, forever.
They're not going to beproactive, they're not going to
come up with some big, daring,great plan and all those things,
(30:10):
but they are steady Eddies.
And so, right off the back, Iwill say, like, if this person
is a steady Eddie, they do wellin the confines of this one
thing.
When I say one thing, I don'tmean one task, but I mean if you
tell them what to do, they'lldo it, but they're just not
going to be creative and they'renot going to do that.
Then you want to ask yourselfis this one I can repurpose?
I'll talk about that in asecond, so let me not get ahead
of myself.
Okay, so the team issues what'smy recommendation?
(30:32):
Okay, now I will start with myobservations, and this is my
observation after studyingthousands of private practices
over the years.
Okay, the number one problemwith most of the teams in
private practices is the teamleader.
Is the physician owner, like weare the problem of our team.
Right, and a lot of times thatproblem is because we don't
(30:55):
define what their role is.
We don't define what their roleis, we don't define how this
role makes money.
We don't have clarity on whatthey're supposed to do.
We have not communicated withthem how to win, so they don't
even know they're in abasketball game and they don't
know where the basket is and,like we're the issue.
Okay For the most part.
So that's an observation I made.
Another observation I made isthat you know.
(31:15):
So that's an observation I made.
Another observation I made isthat you know improperly led
teams are where practice profitsgo to die Because you're seeing
the patients, you're generatingthe revenue, but you haven't
empowered your team, so yourteam becomes dead weight, your
team becomes a liability, and sothey're not creating revenue,
so you are the only revenuegenerator, okay.
So once you stop everythingstopped, once you stop like you
(31:38):
have no support, you feel likeyou're carrying everything
yourself is too much, and I'mgoing to show you how to how to
fix that and so.
So that's where profits go todie, and we just didn't set up
our teams to help us.
To help us with the burden ofownership, with the burden of
creating revenue, right, okay,burden of ownership with the
burden of creating revenue,right, okay.
(31:59):
So what are my recommendationsas how to fix this?
Number one define KRAs, keyresult areas for each role, and
I didn't say key tasks, I saidkey result areas.
So, for instance, for a frontdesk person, we're not saying
well, greet the patients, checkthem in all of that stuff.
Those are activities, those aretasks and those do nothing.
Right, like, of course they'revery important, but oh, my
(32:21):
goodness, those are tasks asopposed to right, as opposed to,
for instance, 100% collectionon all co-pays, deductibles,
co-insurance and old balances.
Right, pays, deductibles,co-insurance and old balances,
(32:42):
right.
We say 100% insuranceverification on all appointments
, right.
We say five Google reviews aday, which means they have to
greet the patients in a certainway, do things in a certain way.
So when the patient is leaving,it's like I hope you had a
great experience.
It would be so much to me ifyou could leave me a five-star
review.
That's how I keep my job.
I'm not saying that's how shekeeps her job, I'm just being
(33:03):
funny.
But when you have theseoutcomes, now their creativity
is unlocked to go, make itpossible and you can show them
like.
This is the outcome.
These are the activities you doto get there.
But when you do that, can youimagine you don't have to bear
the weight of, oh, things werecollected upfront, or we're
getting reviews, or like, you'resharing, you're sharing it
(33:26):
right, okay.
So, and every role in the KRAs,every role, needs to include
serving and earning.
It has to include both.
Okay, all right.
So the second thing I would dois now distribute the outcomes
linked with turning the shiparound.
So we've talked about a lot ofthings.
We've talked about the billers.
(33:48):
We've talked about collectingour old balances, maximizing
daily production.
We've talked about auditing.
We've talked about all of thesethings.
You want to do it with yourteam.
Don't do it alone.
Don't do it alone.
So, for instance, we need tomake sure we're collecting all
the money for what we do.
So the front desk person couldhave collected all the upfront
(34:10):
money, right?
You can have another personthat's in charge of creating
three appointments with thiscash-based vertical that you
want to do.
Right, you have your billerwith the metrics, so they're in
charge of that.
Like, share the burden for thisstuff.
Maybe you looked at your dailyproductivity and you're like, oh
my goodness, like we're seeingfour patients less than I
(34:31):
actually want to see.
They have another person who'sin charge of making sure you see
X number of patients a day.
They're hitting the recaller,they're doing all the things.
But do you see what I'm saying?
Don't just bury it all.
Bury it with the team.
Cast vision with them.
Tell them this is the kind ofpractice we're in.
Tell them about all the privatepractices shutting down and
(34:54):
we've decided we're not going tobe a statistic but because we
can do the things right, shareit in such an inspiring way and
tell them let's go.
They will go with you, okay.
Third recommendation repurposeor de-hire team members as
needed, okay.
So, like the study, eddie, ifyou need to repurpose them where
they're doing something, wherethey're kind of doing the same
(35:14):
thing, and it's a thing thatneeds to be done, doesn't need
to be automated, and stuff likethat, you know, like you kind of
put them in that position.
If they just can't work likethey, hire them, and the sooner
the better, okay.
And again, this is one of thereasons why I like Practice
Pilot.
I think I'm going to keepmentioning it and you can check
it out.
It's practicepilotio.
But this is one of the reasonsI like Practice Pilot, because
(35:35):
it's self-reporting and youdon't want to enter the data.
You want your team to enter thedata, so they will see.
Our goal was to see this numberof patients, but today, oopsie,
this is what we saw, right.
And they're like, oh wait, weneed to fix that.
They're the ones who put in theAR.
They're like, oh, my goodness,and they see that right, and the
person and the insurance andall of those things.
(35:56):
So you want that, because whatit does is it helps your team
see what you see and it helpsthem come to the conclusions you
came to right.
Okay, all right.
So that was the fourth problem.
That was the fourth problem shetalked about.
The fifth problem she talkedabout was her personal finances.
Okay, so there's financialpressure there because she took
(36:16):
out a HELOC, she took out fromher 401k, she got a bank loan
and she used this forrenovations, equipment,
furniture, personal bills, andshe has personal bills still and
stuff like that.
Okay, so what is therecommendation here?
Okay, now, first of all, I willsay this If I was talking to
this person face-to-face, Iwould say you want to be careful
.
If I was talking to this personface to face, I would say you
(36:38):
want to be careful?
Okay, because financialpressure is real.
Financial pressure is hard andit is sometimes really, really
hard to make smart financialdecisions when the pressure
shows up.
Sometimes it's really hard.
Money led decisions like I'mmaking this because of financial
pressure are rarely ever theright ones, and I say this like
I'm almost sending I'm sendingvirtual hugs first.
I know this is hard and all ofthat stuff, but let's walk
(37:01):
through some things to do.
Okay, all right Now, and partof being careful is probably if
you feel under so much pressure,you feel I must make a decision
now.
Now, I must do this now, now,now, now, now, probably decide
to sleep over it when you're inthat state.
Don't make any decisions.
Don't make any decisions, okay,so, so that's the first thing.
(37:21):
Just be careful.
Second thing aggregate all yourdebt, okay.
So, these are all the things Iowe.
This is how much it is.
This is what all the monthlypayments come up to.
This is what the total monthlypayment comes up to.
And talk to all your lenders.
Everything is negotiable.
Everything is negotiable.
So if there could be a pause ofsomething without increasing
(37:45):
your interest rate, that wouldbe awesome.
If there could be a decreasedinterest rate, if they're
willing to do that, that wouldbe awesome.
Talk with them.
If they would do lower paymentsfor X amount of period, again
without changing the interestand changing the terms we don't
want to go from one issue toanother then that would be
awesome.
But don't make the assumptionthat it's not negotiable.
(38:07):
Everything is negotiable.
Everything is negotiable, okay.
Number three I said this before, but I'm going to say it again
prioritize services thatincrease cash flow.
Okay, prioritize services thatincrease cash flow, because we
want cash flow coming in.
The thing that will give youthe greatest peace, right with
this, is bringing in revenuethat makes up for that.
(38:29):
Okay, all right.
And one of the things was youknow, do I sell my house or do I
not sell my house?
I would say it depends on youreally want to think about that.
For instance, if you're like Iwas looking to sell in the next
one to two years anyway, and youhad a home that has so much
equity in it, it had a lowinterest rate, all of that stuff
, and you'll be able to sellthis, buy what it is you want
(38:52):
now, and then you have profitsoff of that that you can put
into whatever you want to.
You can do that.
If you're not thinking aboutselling it at all, and maybe you
got a house in the last twoyears and all of that stuff and
it's just going to be a lose,lose, lose, then you want to
think maybe of not doing that.
But what I will tell you isthere are multiple loans here
(39:12):
and you don't have multiplehouses to sell, right?
And so you kind of want tothink of what would I do to get
myself out of this, outside ofthe house, and then say, okay,
do I want to go all in on doingthat and then keep my house.
You see what I'm saying.
So there's a lot of thinkingthat needs to go into that.
But I would say no hurry to dosomething that is fairly
(39:37):
permanent off of something thatis temporary.
Does that make sense?
So that's the way.
But there's more, there's a lotmore conversation.
So I would say you want to bestrategic with what you do here?
Okay, but definitely talk toyour lenders for sure, for sure
and for sure.
Get that cashflow engine going,bringing revenue in and all of
(39:58):
those things.
Okay.
So lots of stuff.
And so this is the last one andit's mental exhaustion from all
of this.
Okay, and I'm going to readwhat this doctor said.
I think it's important becausethis is what she says.
I'm a solo doc.
I've always done it alone.
I haven't had mentors orphysician colleagues to bounce
ideas off.
(40:18):
I feel isolated.
I'm a black female physician intown with only two to four
other black females in privatepractice, but there are 30 to 40
doctors in my specialty in thistown and all that stuff.
I'm losing hope.
Okay.
So again, first of all,specialty in this town and all
that stuff.
I'm losing hope, okay.
So again.
First of all, long.
You know the long squishy huglike long, squishy, big,
(40:40):
understanding hug and all ofthat.
And I do want to say, you know,thank you so much for what you
do, because you've chosen toserve people for this long.
You've chosen to build your ownhealthcare system, which is
really what we do as privatepractice owners, and think of
what thousands of people whowould not have access to great
care if you didn't say yes todoing what you do.
(41:01):
So big, big, big hug.
And I want to say theprinciples of rest.
Sometimes it's really hard withwhat you're going through, but
there's rest, there's meditation, but there's also a support
system and I want you tounderstand that, no matter what
it's out there, you can have asupport system.
(41:24):
It may look different, you mayneed to get a little creative
right.
Some of them may be outside ofyour area and some of them may
not even be close to you.
They may be online.
I have such great relationshipswith some doctors who've poured
into me so much and who I'vebeen able to bounce ideas off
and all of that, and I haven'teven met them in person.
(41:44):
Some of them I met them inperson after three years.
You know what I'm saying and soI don't want you to accept this
, the fact that you can't have agreat support system.
I want you to know that youdeserve a great support system
and then build it.
They may not all be in yourarea, they may not all be like
you, they may be online and allof that stuff Just refuse to
walk alone, right?
(42:05):
And so what is a good startingpoint?
In the communities where you dofind yourself, show up, ask
questions, talk to people,schedule lunch dates, schedule
Zoom meets, zoom meet and greets, have conversations, start
networking and you find yourpeople, or people who know your
people, and all of that stuff.
Right, I will start, but I willstart from this thing that of
(42:26):
course my support system is outthere and of course I deserve a
great support system.
And no, I am no longer going towalk alone.
I'm just not going to do itright and know I am no longer
going to walk alone, like I'mjust not going to do it right.
And so, whether there's spacesonline, you know, if we have a
number of communities, we havethe Profitable Private Practice
Movement, like if you're part ofthat, like when you come in
(42:46):
there, show up, show up in thecomments, connect with people
and then take thoserelationships offline and stuff
like that.
Like, do that.
The Entre Ambi Business Schoolis another one, huge
relationships offline and stufflike that.
Do that.
The EntreMD Business School isanother one, huge, huge, huge
one.
Right, and build your owncommunity.
And in a time where most peopletalk about private practice
being dead and you can surviveand woe is us and all of those
things find people who aresaying the opposite.
(43:07):
Find people who, like you, wantto take their practices from
not doing really well to reallyreally profitable, to thriving.
Right.
So do that, right.
So show up in those spaces andstart building those
relationships.
Okay, set a target for yourselfthree, then six, then 12, then
whatever and build that foryourself, okay.
(43:28):
And then you know so good, well, it always comes back.
You know what I mean.
And so when you have anopportunity to help somebody and
when I say help, I don't wantto mean like you shut down your
office for a day and go do stuff.
I'm not even talking about that.
I'm talking about simple thingslike somebody opened a new
practice and you're mailing thema card and saying, oh my
goodness, congratulations,welcome to the area.
(43:48):
Somebody gets an award.
You like, congratulate themSomebody.
It seems like they'restruggling, you encourage them
and stuff.
It's goodwill, and the thingabout goodwill is it's going to
come back to you.
It may not come back from theperson you showed goodwill
towards, but it will come backfrom somebody, right?
And so do that.
Do it knowing that I'm justsowing these seeds and they're
going to come back to me, butrefuse to walk alone.
(44:11):
And if you look in your circle,your network, your area, you'll
find that there are people Ican show goodwill into and there
are people that I can starthaving conversations with and
start building that supportsystem, right, whether they're
online or they're in person andstuff like that.
And so I know we went through alot of stuff, but I hope out of
(44:31):
this you can build out likethis is where I'm going to start
from and revenue you reallywant to to start, you want to
really want to start with fixingthe revenue and all of those
things.
But you have things that youcan say okay, these are the
seven strategic things I'm goingto do over the next 30 days
with my team.
So, with your team, you can doseven right, like I'm going to
do over the next 30 days to putmy practice in a position where
(44:54):
we can start the process ofthriving right.
And these are the things youcan map out.
And if you have questions, youknow for everyone who's watching
the comments and all of thosethings like post them in the
comments.
I will come back.
I may make a whole video on allof those things, but for this
doctor, I want you to know thatI am rooting for you.
I believe in you.
Obviously I support you.
(45:15):
I that I am rooting for you.
I believe in you.
Obviously I support you.
I guess I'm one of yoursupporters, right?
I support you and I reallycannot wait to hear about you
turning this around.
I know that, yes, it's going tobe challenging.
It may even get a little harderbefore it gets easier, but I
know you can do it and I knowyou have the strategy and I'm
rooting for you.
Stay connected to us, whetheryou're in PPPM or you're reading
(45:38):
the Profitable Private PracticePlaybook, and we have so many
resources.
If you have questions, justpost them in the comments.
I'll come back for it.
Okay, now I want to challengeeveryone to take the link of
this video watcher.
If you're listening on thepodcast, I want you to take the
link and share it with everyprivate practice owner you need,
because these are strategiesthat work, whether your practice
is struggling, or your practiceis profitable, or your practice
(46:02):
is thriving right Like theseare the things we want to stay
on top of.
So we continue to thrive,because the more we thrive, the
better it is for our patients,the more empowered physicians we
have, and then we now have agroup of people who can go into
the healthcare system and turneverything right side up.
Okay, all right.
So absolutely rooting for youand I'll see you on the next
(46:23):
episode.
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