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.

BLOG: $10 million club: Solving problems on the way to becoming a much larger practice, part 1

Only a small percentage of ophthalmic practices in the nation ever reach $10 million or more in annual collections. But the lessons learned along the way by these market leaders are critical to pass on to practices still striving for this benchmark — and perhaps equally valuable for surgeons with more modest business goals.

You’d think that the owners of these larger practices had it made. But interestingly, practices in the “$10 million club” have an even greater difficulty than smaller practices deciding where they should be heading next. Doctors in these practices often reach an elevated threshold, beyond which it’s difficult to conceive their next strategic destination.

This cohort of major practices typically has many characteristics in common. Starting at the top, they generally have one highly driven, charismatic leader — often the founder. But the doctors next in line below this lead doctor rarely have the same talents; the pool is simply too small. Unlike a large manufacturing firm that can choose from thousands of potential CEOs, inside and outside of the company, large practices can only turn to a handful of ascendant partners or partners-to-be, or must be ready to relinquish control to the skills of a superior lay manager.

Being the managing partner of a $10+ million practice is more than 10 times the challenge of leading a $1 million practice. And the two best solutions for this problem take years to unfold — grooming an existing partner for the job, or seeking out in the next partner-track associate a doctor with proven leadership talent. Which means that the leaders of larger practices can’t put off until the bitter end their selection of a successor. In small practices, the partnership can draw straws to pick their next leader and turn out just fine. In large practices, the wrong grooming and selection of a leader can cripple the company, especially as management difficulties continue to compound in the future.