February 04, 2014
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BLOG: Is your practice large enough? Part 1

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Read more from 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 ophthalmology practice? Should your practice even have a defined set point, a growth boundary, at which it stops and reverts to homeostatic operation without growing further? Can a practice grow to unbridled, “cancerous” levels?

After nearly 4 decades of examining thousands of practices and their revenue growth curves, I’m struck by the fact that most practices don’t grow steadily. They more often reach periodic plateaus, rest at that level for longer or shorter periods of time, and then take off again to higher levels.

Examining the historic financials of these practices as a consultant is a little like a forester looking at the cross-section of a large tree. Adjacent rings on a tree stump show periods of fast and slow growth, periods of quiescence and even stunting. Some practitioners stay put once they reach a plateau, although few seem to do so any more consciously than a tree.

Most eye surgeons want to keep pushing through successive cycles, growing to reach new and higher benchmarks. And of course, some practices remain stunted despite their owners’ best efforts.