Nine pearls for making better practice business decisions

“Most of us are going through life without interrogating whether our decision-making processes are fit for purpose. And that’s something we need to change.”
– Noreena Hertz

“Informed decision-making comes from a long tradition of guessing and then blaming others for inadequate results.”
– Scott Adams

In the span of a 30-year career, with perhaps an arbitrary three decisions per patient visit and more than 5,000 patient visits a year, the average ophthalmologist has to make something like half a million decisions in the course of a full professional life.

And that is just the medical and surgical decisions. The decisions you were deeply trained to make.

But there is more. If you own a practice or have a leadership role in your clinic, there are also business enterprise decisions to make:

• “Should we open on Saturday mornings?”
• “Should I fire my administrator or give him another chance?”
• “How high should we set our growth trajectory?”
• “Is it time to abandon LASIK and focus on my general/geriatric practice?”
• “Should we buy or lease our next satellite office space?”
• “Is it time to add a partner-track associate?”
• “Should I sell my practice to a private equity firm or merge with a larger local practice?”

Several factors make these business decisions so much harder than the clinical decisions you glide through daily:

• You were likely never trained in business.
• There are fewer business decisions to make, so you get less practice.
• There is only limited anecdotal literature written about what works best in the business of medicine.
• Many business decisions are not binary (like “yes surgery/no surgery”) — they involve shades of gray or degrees of action.
• While there is often one/best clinical decision, there can be several perfectly acceptable business decisions regarding any one problem or opportunity.

Honestly, making business decisions is not all that much easier for professional businesspeople, irrespective of their experience or training. Each CEO or manager tends to develop over time their own bespoke approaches and pearls to solving business problems and seizing opportunity. Here are nine pearls we have developed through the years to help clients that may be helpful to you.

1. First things first. Our first maxim is that every decision should be guided by the answer to three questions, posed in this order: Is the proposed action legal? Is the proposed action ethical (ie, does it align with your values)? Is the proposed action more profitable than the other ethical and legal alternatives?

2. Gather info, decide, act, assess. Just as in your medical life, business decision-making depends on first gathering a sufficiency of information. A majority of the time, if you are stuck on a decision, it can simply mean you have not gathered enough information yet. Once you have the facts, decide. Once you decide, act. Making a decision without acting on it is as pointless as making a decision without the facts. Finally, assess the wisdom of every important decision. Look back and with hindsight ask yourself, “Did I make the best decision possible?” These kinds of lookbacks will make you a better business decision-maker in the future.

3. Consider every possible solution. Most business problems have multiple solutions. Let’s say you have determined that your practice is overstaffed compared with peers. There are numerous solutions to this common problem: You could live with transient overstaffing and let attrition taper your workforce. You could preserve the overstaffing because, as a doctor, you like your patients to have more of a “spa” experience than a “clinic” experience. You could increase patient loads. You could trim hours here and there selectively. You could terminate one or more of your least effective staffers. You could employ the excess staff hours on a special project such as outreach or outcomes measurement. Whenever you have a problem, brainstorm and write down all of the possible solutions before you make a decision.

4. Ask the stakeholders. Most clinical decisions are 100% on you, face to face with a patient. That is why many physicians have impaired instincts when it comes to making business decisions, which are much more collaborative. Make sure you ask yourself before every important decision: “Have we received input from all of the stakeholders in this matter?”

5. Begin with the ending in mind. Ask yourself, “What outcome do I really want here? If we take the proposed action, what are the odds of achieving this outcome? Will our decision treat the root cause of the problem or just mask the symptoms? What adverse side effects might crop up? If we are surprised by a bad outcome, can we reverse our decision?” As a physician, this is a familiar process. Always think ahead.

6. Choose the proper kind of advisor. This involves judgment at two levels. You need someone with the appropriate subject matter expertise (a lawyer for legal problems, an accountant for taxation issues). You also need to choose someone who fits your immediate need: You may be better served by a directive advisor for some matters. As an example, you might turn to a trusted peer to give it to you straight when you ask, “Should I buy a laser system from Company X or Company Y?” Or you may be better served by a more suggestive advisor when you need more of a sounding board, someone who can help you explore the pros and cons of a decision.

7. Do not dawdle. As obsessed as most surgeons are with perfection, it is sometimes hard to distinguish between thoroughness and mere procrastination. Here is a gambit we sometimes pull out for clients who are stuck on the fence between two perfectly reasonable options. We have them light and hold an old-fashioned kitchen match, which can burn for about 30 seconds before it reaches your fingertips. Then we say, “Now please make a decision before you get burned.” Most clients are relieved to finally blurt out whatever decision they intuit in the moment is best. Of course, a few do get singed from time to time. Longer matches might help.

8. Consider technology. With the advent of ChatGPT and other AI platforms, you have a new and often useful (even if a bit weird at times) tool for decision-making. Here is an example. We posed this simple question to ChatGPT: “When should a 50-year-old solo rural ophthalmologist consider adding a partner physician to their practice?”

To which we received a 672-word reply; here is a brief excerpt:

“A 50-year-old solo rural ophthalmologist should consider adding a partner physician to their practice under several circumstances. Here are key factors to evaluate:

• Workload and burnout prevention.
• Succession planning.
• Specialization and scope of care.
• Work-life balance.
• Financial risk sharing.
• Clinical support and collaboration.

“Ideally, the decision to bring on a partner should occur several years before it becomes urgent. If the ophthalmologist feels they can no longer handle the workload alone or anticipates long-term health concerns or retirement, it is better to initiate the process earlier to ensure a smooth transition. Overall, the decision hinges on the ophthalmologist’s current workload, future goals and the long-term viability of their practice.”

Like all AI pronouncements, the verbiage can read a bit like a horoscope or fortune cookie. But it can stimulate further discussion and inquiry. If you are stuck on a decision, having a back-and-forth discussion with your laptop may help get you unstuck.

9. Reverse your bad decisions quickly. Unlike medicine, business is not the land of 100%. Business is a little like the military: making 60% correct decisions and executing with overwhelming force. The result can sometimes be expensive, embarrassing or dangerous. Do not hesitate to reverse course. It can be perfectly acceptable to rehire a worker fired in haste, fire an associate you had pinned your succession hopes on or pull the plug on a long-planned project.

• For more information:
• John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.

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