• John B. Pinto, Practice Consultant and OSN Section Editor, focuses his blog on ophthalmic strategic planning, economics and benchmarking, marketing, cost containment, revenue enhancement, physician leadership and personnel/physician career development issues.

Wednesday, April 23, 2014

Practice lessons from naval submarines, part 2

John B. Pinto

Consider the following practices, Practice A and Practice B, I am about to describe. Practice A’s routine procedures are in writing, and these reference materials are easily accessed when a question surfaces. Practice B’s procedures are all in people’s heads, and the operational integrity of the practice degrades every time a staff member leaves. Initial training at Practice A is formalized and intensive; new staff are competent in their jobs before being allowed to operate c...

Monday, March 31, 2014

Practice lessons from naval submarines, part 1

John B. Pinto

Living in San Diego in the shadow of America’s nuclear navy, I once had the privilege of touring a real, live submarine, courtesy of an admiral friend. In 60 minutes, I learned more about the value of staff cross-training than I had learned in all the previous years as a practice consultant. I also picked up lots of other management pearls. I’d like to share a few of these insights with you. Virtually all members of a 135-man submarine crew (U.S. submarines are essentially all-male...

Friday, March 14, 2014

Is your practice large enough? Part 5

John B. Pinto

This topical blog series on practice scale would not be complete without an acknowledgement that not every surgeon needs to be in a growing practice to be happy. Although it’s rare today, many of us can still remember when a significant percentage of specialists would actually close their practice to new patients. Some surgeons in today’s over-amped, multitasking world are considering the modern equivalent of downsizing to limit the practice to their core interests. I visit with an i...

Thursday, March 6, 2014

Is your practice large enough? Part 4

John B. Pinto

Development in all its forms — adding new services, new facilities, new staffing or new patient volumes — is often perceived to be the foe of smooth operations. So doctors who don’t think their practice is prepared for growth will keep holding up progress. This is extremely frustrating for their lay managers. It’s clearly true that growth in any form will be accompanied by operational snags. And the faster a practice builds, the more snags will arise. Try to not use these...

Wednesday, February 19, 2014

Is your practice large enough? Part 3

John B. Pinto

In a practice eager for sustained growth, there are usually one or more defining incentives. These usually take the form of personal financial rewards for the surgeons, although there are prominent exceptions. I have more than one client for whom profit growth is mainly an opportunity to fund their charitable work. For most, old-fashioned competition is a common motivation: “Dr. Winters has just eclipsed my case volume — I’m no longer the No. 1 surgeon in town.” However, ...

Friday, February 14, 2014

Is your practice large enough? Part 2

John B. Pinto

The largest single influence on a practice’s development trajectory is doctor ambition and a willingness to risk both capital and colleague jealousy. A gung-ho physician in a tough, doctor-saturated market is generally far more successful than an average doctor operating in a market that is underserved and ripe for conquest. The same competitive instincts that drive some surgeons to the top of their class often lead them to be winners in a raw commercial sense, as well. A manager’s a...

Tuesday, February 4, 2014

Is your practice large enough? part 1

John B. Pinto

The concept of homeostatic “set points” is well-understood in biology and medicine. A healthy 6-foot male patient of average build will settle in at about 180 pounds. A healthy ecological niche will reach a carrying capacity of just so many frogs or robins, and no more. Healthy cells will grow and divide to make a tissue; healthy cells don’t grow rampantly to form a cancer. But what about a healthy practice? What should be the set point of a growing solo or group ophthalmolog...

Wednesday, January 8, 2014

The cash flow benefits of continuity of care part 3

John B. Pinto

Picking up where we left off last time regarding recall and continuity of care, let’s check in on how your practice is doing in this critical area. Take this simple test in your practice (assuming you are still using paper charts).  Pull 20 charts at random, per doctor, of patients last seen 2 to 3 years ago (but not in the last year.)  Then fill out a chart that looks like this, with one line for each patient: Patient Account Number Age Month & Year of Last...

Wednesday, December 18, 2013

The cash flow benefits of continuity of care, part 2

John B. Pinto

When we do the math on the kind of neglect described in my last blog, the impact of superior continuity becomes obvious. Imagine two competing senior-oriented practices. In year 1, they each get a new 65-year-old patient with the average incidence of eye care needs. Let’s say these patients each have the potential to stay in the practice 10 years, and that in the aggregate of medical and surgical care, they average $150 per visit in eye care outlays. And assume these patients, after a plea...

Monday, December 9, 2013

The cash flow benefits of continuity of care, part 1

John B. Pinto

Influenced, perhaps, by the now-rampant business mantra of efficiency at any cost, we live in an era of cutting corners. “Can we do without that test? Can we skip that last step of documentation?” I’m all for efficiency, especially in practices larded with rules and routines that drag down profits and don’t add value to patients. But taken to extremes in your practice, cutting corners can have an unintended and remarkably large adverse effect on practice growth. This i...