Non Clinical Revenue Generation

Guest post by Jordan Grumet MD

Although I mostly expound on the trials and tribulations of practicing medicine, for a guest post, I decided to write about being a small businessman. 

Running a successful private practice can be both difficult and time consuming.  With the recent passage of health care reform, many physicians fear the security of their current income streams.  As primary care doctors, we face the ultimate catch twenty two.  The better job we do, the less outpatient visits and hospitalizations are necessary, the less money that flows through our doors.  Talk about perverse incentives!  Many have thrown their hands up in the air and joined the local hospital or medical group.  For some of us though, the loss of personal freedom is a major concern.  

So what is the burgeoning physician/entrepreneur to do?  How do we continue to be captain of a ship that faces a tsunami of change?  For me, the simple answer lies in maximizing non clinical revenue generation.  

Over the years, I have established myself as a medical expert, nursing home director, and writer.  Each of these activities provides consulting fees that are more lucrative than patient visits, require little or no overhead, and develop new personal goals and interests.By diversifying my skill set, I have created a more stable and enjoyable practice environment.  Furthermore, my time spent in the clinic is more concentrated and busier than ever.  I no longer need to try to actively recruit new patients.

There are many different nonclinical revenue streams available to physicians.  Besides those mentioned above, there are opportunities with pharma, chart review, and biotech to name a few.  Either way, I no longer worry about the traffic through my exam room door.  Most importantly, I am able to practice parsimonious, appropriate care and still bring home a salary that I'm proud of.  

And I learn something new each day.

About: Jordan is an Internal Medicine physician practicing in Highland Park, Illinois. He blogs at In My Humble Opinion.

Physician Self-Leadership

The most challenging one to manage is you.

Self-leadership isn’t a concept most physicians think about very often.  Yet leadership capability relates as much to how we lead ourselves as how we lead others.  Some of the greatest barriers we face along the path to "making things happen" lie within us.

Most physician leaders can trace their greatest obstacles to something personal—a fear, insecurity, or self-imposed limitation.  As we consider past conflicts that really drained our energy—such as a partnership that didn’t work out or a team that fizzled under our watch—we must challenge ourselves to acknowledge our role in the failure.  Our flawed judgment is often the root cause.

As you lead others—in clinical practice or in a non-clinical role—you may very well be your greatest liability.  Self-leadership is about awareness, tolerance, and not letting your own natural tendencies limit your potential.

Find a Path to Self-Awareness

The forces of organization, community, and leadership capability often evade us because our tendencies—to generate more ideas, to isolate ourselves, and so on—get in the way.  Our best hope for staying on track is to notice when we drift off course and to figure out why—to be self-aware.  Self-awareness is a critical skill in leadership, but it is deeply personal.  It is not about our actions but about the emotions that trigger our actions.

With increased self-awareness, we become better students of ourselves.  When we make mistakes, we are able to identify what we could have done better more readily.  When we receive feedback from others, it becomes more actionable as we come to understand its correlation with our emotions.  The path to self-awareness never ends, but we must cross it nonetheless.

Learn From Your Mistakes and Failures

Most of us have a hard time with failure because we feel not only the professional loss but also the personal hurt when our ideas fail to gain traction.  But this tendency poses a problem for us as we commit ourselves to act without conviction.  Projects that encounter or end with failure have great value—but only if we can recognize it and reap the benefits.

When we experience failures, we must remain open to the lessons that can be learned.   Grasping the realizations that come with failure is a crucial part of the learning process.

When something goes wrong, there are three questions we should seek to answer: What external conditions may explain the failure, what internal factors may have compromised our judgment, and are there any “gems” in the unintended outcome?

Avoid the Trap of the Visionary’s Ego

During my time in the medical device and pharmaceutical industries, I had the opportunity to participate in a lot of meetings in the executive suite during both the expansion and bursting of the bubble that followed it.  I always found it interesting how every challenge was presented as an unusual one-off.  The business leaders would nod their heads in affirmation.  “This is an unusual time," someone else would say. 

Despite history, the tendency to think that a given opportunity or challenge is a one-off still persists.  Some call this tendency “visionary’s ego,” when a leader’s default thinking is that he or she is the exception to the rule.  As physicians, we may be susceptible to bouts of this form of narcissism.  While our tendency is to approach every situation with a fresh set of eyes, we should also accept a grounding realization: not much is entirely new—and yes, we can learn from the past.

Challenge yourself to have some perspective.  Don’t get caught up in the novelty of what you are doing that you lose touch with what’s been done before.  As you encounter negotiations in healthcare organizations, collaborations with partners, or unique decisions or investment opportunities in your business, ground yourself with the fact that the situation you face isn’t as isolated and unique as you might think.  Previous knowledge is yours for the taking, often risk-free and time-tested.  Today never feels like it will be history, but it will.  And more than likely than not, you will look back and realize that you should have known. 

Challenge Conventional Wisdom

As you harness the lessons from the past, you must also question them.  Of course, nobody should disregard good advice and fall victim to visionary’s narcissism.  But as physicians, we cannot become imprisoned by the status quo.  We need to reconcile our tendency to seek the advice of experts with out desire to do things differently—and perhaps better.  We should be wary that “best practices”—the tried and true ways of doing things—often become conventional wisdom—and conventional wisdom is often wrong.     

Consider Yourself an Entrepreneur

Whether you work for a large corporation or on your own, when it comes to leading ideas, ultimately you are an entrepreneur.  Entrepreneurs are not the ones with the best ideas, says Andrew Weinreich, a trailblazing entrepreneur, “They’re just the ones willing to jump off a cliff without the answers." 

Some feel the hardest part of pursuing a new venture is pulling the trigger—being mentally into it or not.  So, when you come across ideas worthy of your time and energy, it is important to know which assurances you need—and which you don’t—before you decide to take the plunge.  You will never have all the answers, but you need to feel that the risk of giving it a go is less than the risk of not trying.  You don’t need to see the finish line, but you do need enough momentum to stay afloat.  What matters most is your ability to keep moving your idea or venture forward, day by day.   

Be Willing to Change Your Mindset

Physician leaders who have done extraordinary things often talk about times when they made decisions that were unpopular—but necessary for their success.  Perhaps it was leaving clinical practice to pursue their passion—or quitting a well-paying job to start a company.  Maybe it was saying no to an opportunity that seemed golden to others.  Because of their decisions, their paths were unconventional.  But in the midst of discouragement from their families and friends, they persisted and gained confidence from being challenged. 

Just remember that the uncharted path is the only road to something new.  As pressures mount, you need to stay the course and consider the doubts of others as an indication of your progress.  

Keep an Eye on the Clock

In hindsight, it’s easy to talk about assuming a different mindset and defying the status quo.  But it is very difficult to take the leap.  Many of us postpone our dream pursuits for a whole host of reasons.  We’re waiting for the right time—but are not sure when that time will come.  We may have good reasons for not doing something, but we pay a price for postponing action.

Consider keeping an eye on what you’ve done with your time.  Think about the last time you sat through a dull meeting.  Recall how you tuned out the conversation but became aware of the time you had lost.  During that time, were you taking any risks to develop other opportunities or move a new venture forward? Were you marketing yourself for an opportunity to get closer to your true passion—or develop a new area of expertise?  Were you expanding your network and connecting with the opportunities around you? Depending on your point of view, this could be either a painful reminder of wasted time and lost opportunity—or a motivational reminder to use every minute to pursue your dreams in the next chapter of your life.  

Who Is Your Ideal Client (and Why Should You Care?)

I’ve spent a lot of time over the past year trying to identify who my “Ideal Client” is. 

The ideal client is that person, or group of people, you are most likely and able to help with your business’s product or service.  It’s a marketing term.  Knowing who your ideal client is also helps you identify who you most enjoy working with.  It doesn’t make much sense to serve a particular group of people if you don’t really like working with them or having them as customers.

The exercises that have helped me hone in on my ideal client have also added much to my understanding of what I actually do in my business, how I do it and why I do it.  I learned these exercises from one of my mentors, the creator of Conscious Marketing, Lisa Cherney http://consciousmarketing.com.  The first sentence of her website reads, “We specialize in identify your passions and helping you articulate it through your marketing communications.”

It becomes much easier to create a marketing message when you figure out what you are really passionate about doing, whom it is that you are meant to do it for, and whom you most enjoy serving.

I’ve determined over the course of my career that I’m passionate about helping many people see their own potential for living life fully and on their own terms, and then helping them move in a positive direction to achieve that.  It's not hard to see how being an ER doctor wasn't completely fulfilling that vision for myself.

Fast forward to 2011 when I began my coaching practice.  I initially decided to offer my services to doctors, because I know how many doctors would benefit from what I offer and I know how powerful it can be for doctors to find their true path and get re-inspired.  Everyone wins when that happens.

But as I was doing my exercises and soul-searching to hone in on my ideal client, I wasn’t visualizing a doctor. In fact, my ideal client didn’t have one specific job, or a specific age range, gender or skin color.  They might be married or single, have pets or not, drive a sports car or a pickup truck.

After more than a year of ongoing work in this critical element of my business, I'm happy to say that I have finally been able to identify three characteristics that every single one of my ideal clients shares:

1. They are at a transition point in their life and are trying to figure out how to best go forward
2. They are ready to do things differently than they have before- they are open to a new way
3. They want to have a positive impact on the world

Many doctors fall into this category, but so do many writers, teachers, lawyers, artists, entrepreneurs, students, retirees, gardeners and coaches.  My ideal client is actually me, a few years back.  Not the “me” that was a doctor—the “me” that was a human being passionate about creating an amazing life of freedom, joy and abundance, and committed to serving humanity in a meaningful way.

The ideal client exercise is a great way to help you get clarity on who you are best able to and interested in serving.  Doctors should spend whatever time and money necessary to figure out who their ideal clients are.

If a doctor determines that they are especially passionate about working with people who share a certain set of characteristics (perhaps working with people trying to become more physically fit, or people trying to lose weight, or young parents) they can focus their marketing energy and dollars on reaching out to these groups and will ultimately develop a niche in that area. People will want to come to that doctor because the doctor wants to serve them. The doctor will surround themself with the people they most enjoy working with- a clear win-win.  It may not happen this way overnight, but it will happen if they're committed to it happening.

The ideal client exercise spreads out to other areas of life too.  As we start thinking about whom we most want to serve in our businesses, we can’t help but consider the characteristics and qualities of the people we want to spend time with in the rest of our lives.  We start to “weed out” those relationships that don’t add value and focus on surrounding ourselves with people of higher quality and substance with whom we are more aligned.

I hope this has stimulated some thoughts for you.  I would enjoy hearing from you about the ideal client concept and how you think it could apply to your life and career.

Wishing you health, happiness, peace and prosperity.

Making Things Happen As A Physician In Transition

Overcoming the obstacles between dream and reality.

You’ve thought a lot about leaving clinical practice and transitioning to a non-clinical career.  You considered starting your own internet business or writing a book or investing in real estate.  You thought you had a good idea at the time.  So, what’s keeping you from making it happen?   

As a physician, you’ve probably considered many great ideas—or dreams—about your future.  But those dreams have little value, if you don’t follow through and make them a reality.

If you have encountered obstacles in executing your ideas, you are not alone.  Countless ideas with the potential to transform lives—concepts for new medical products or models for new businesses—are probably conceived and misspent in the hands of talented physicians every day.  The ideas that move people forward are not the result of tremendous creative insight—or inspiration—but rather of masterful planning and management.

Successful entrepreneurs tell us that ideas don’t just happen by accident—or because they are great.  Whether you have a solution for an everyday problem or a bold new concept, you must transform your vision into reality.  Far from being some stroke of creative genius, this capacity to make ideas happen can be learned and developed by anyone. 

Success depends on making things happen

Whether you are in clinical practice or in industry, success depends on developing and executing new ideas.  You may come up with creative solutions to medical problems every

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Stop Asking Permission

Here's to the crazy ones.

When we talk to our physician readers at conferences or during coaching sessions, several themes keep coming up again and again: Doctors think they don’t have enough time, enough money or both.

When we coach them, we usually ask them “What could be a way out?”. Very often the response is – silence. Physicians are very often unispired when it comes to creative solutions to their own job frustrations.

Why is this so? We think that it’s the physician-mindset which is the problem. We, as physicians, have a permission-based approach to work. All our lives, we had to get permission for doing stuff: we had to get permission to attend a good high-school, a good college, a good medical school etc. After graduating from medical school, we had the permission to practice medicine as a resident, after the board exam we got another permission, then we go into a sub-specialty and we get yet another……you probably guess it: permission.

So whenever we ask our readers, friends and clients: “…you have passion xyz, why don’t you just try to make it a side-busienss?”, we usually hear: “because I was not trained to do that.” Which basically means: “nobody gave me permission.” Do you think Steve Jobs would have come up with the Apple empire if he had a physician-mindset? Do you think that Mahatma Gandhi was trained to be the leader of a peaceful revolution? Do you think that Richard Branson got permission from anyone to start his multimillion empire? The answer is of course – “No”. And why “No”? Because most of them were the first ones to do the shitake they were doing. There just was no one around to teach that stuff.

So what do these successful people have in common?

1. They had an idea
2. The courage to start
3. The self-discipline to follow-through
4. The abilities of an autodidact

You passed all those difficult hurdles, you went through medical school and you probably are used to busy and exhausting work of a healthcare setting. So it is very likely that you have the stamina to follow through. We also assume, you are a quick and autonomous learner. Moreover, as we know from our talks with many of you, you might even have an idea. It is cristal clear, what’s holding most of you back from just f*n doing it is: FEAR. You don’t yet have the courage to start. And we will change that.

Doctors Underestimate Their Options

Most of us who studied medicine went into medical school thinking that they were going into the coolest profession that was ever invented. It’s exciting, it’s intellectually stimulating, it’s well respected, it’s well paid etc. etc.

Many of us started to work as physicians after medschool and realized that there were parts to our work that we did not like that much: the long hours, death, grief, paperwork, administrators, bad pay (but everyone told us that doctors were rich?).

Some of us did not get over these undesirable aspects of the physician life, they are unhappy with what they are doing but unable to quit….after all, this is supposed to be the coolest profession (remember?). Plus, what would my friends, parents, grandparents, …. (fill in blank) think of me?

Very few of us jump in at the deep end and either don’t start to work in medicine or quit this highly respected profession to do whatever feels best to them. Many of those who are stuck, who don’t dare to exit think that there is really nothing else they can do. Think twice. You are highly educated, smart, creative, eloquent, analytical. Otherwise you would have never made it into medical school.

There are tons of jobs out there waiting for you: be it as a medical writer, entrepreneur, public health expert, medical advisor to the industry, teacher, speaker, blogger, coach, psychotherapist, angel investor etc. etc. etc. If you are one of those people who think that you are not creative enough to come up with alternatives to your current job, this video is for you.

The Medtrix

What is The Medtrix? It is the medical career that has been pulled over your eyes to blind you from the truth: that you are a slave.

Look, I've come to terms with the fact that I'm a massive nerd. I can only parse the world through the lens of science fiction movies I've seen. Don't laugh now—it's a real condition with its own ICD-9 code: 003.14, Dorkiness NOS. The typical signs and symptoms include choosing Internal Medicine as a career, owning 20-sided dice, and receiving unexpected wedgies at cocktail parties from orthopods named Chip.

But after working as a full-time clinical hospitalist for almost 9 years now, I'm starting to appreciate some eerie parallels to the sci-fi classic The Matrix. Although I admit I have yet to see a single doctor at the hospital wearing a skin-tight leather bodysuit. Scrub-chaps, maybe, but no leather. Wait, where was I?

Oh yeah. For many of us practicing clinical medicine, the world can sometimes take on an unreal, dreamlike quality. Like we're going through the motions of someone else's life.

Have you ever had a dream, Neo, that you were so sure was real? What if you were unable to wake from that dream?

For the majority of my clinical career, I've had this nagging feeling. I'm suspecting many in medicine today may have felt similarly: that the REAL world is out there, and we're trudging through someone else's construct instead. The key question we have to ask ourselves is less HOW to escape the Medtrix, but WHETHER to escape.

You have to understand, most of these people are not ready to be unplugged. And many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.

Take the blue pill, continue along your current path. Take the red pill, and see what fascinating opportunities await you outside of, or in addition to, the confines of clinical medicine. One thing though: avoid the brown pill. Trust me on this.

Over the next few weeks and months I'd like to drag you through my own journey from pure clinician to…well, like any good sci-fi series you'll have to stay tuned to see what happens! Hang tight and together we'll see how deep the rabbit hole goes.

You have to let it all go, Neo. Fear, doubt, and disbelief. Free your mind. Welcome to the real world.

"Whoa."