Physician Creativity & Disruptive Innovation In Medicine

Making way for your creativity.

Whoever said “a creative mind is rarely a tidy mind” was on to something. Who hasn’t had a great idea for a new product that they are sure would make them rich? Whether it’s a new medical device that fills a client need or a new service that will increase your revenues, how do we know what really makes an idea “great”? Why do certain bad ideas get to market and great ideas never make it to market?

Inventions that have taken a forward-thinking approach at their very beginning often appear backwards in their thinking given a few years (or decades) of retrospect. For example, what about the birth of individually packaged goods, which made food both convenient and transportable? Was anyone thinking about how all the materials they were using were creating more waste for landfills? The side effects of our creative ideas can’t always be anticipated. 

Innovation flourishes when there is a desire to make our world stronger, faster, cheaper, convenient and more beautiful. These are the desires that keep the most creative innovators inspired. But, some of the most innovative ideas and solutions we imagine can create other problems as a result.

The best way to reduce the risk of negative side effects is to follow a series of “filters and qualifiers” that will help separate the brilliant long-term solutions from the quick fixes and the genuine needs from the flash-in-the-pan fads.

Certainly medicine and health care has it's own set of filters, but there are basics that apply across all playing fields. Following are a blend of the best practices from the world of medicine, architecture and social entrepreneurialism. You can use these with confidence when fleshing out your ideas. Review them, use them and embrace them – they will save you both time and money. 

Step 1:  Take the time to understand your market

This step starts with the simple question “Is my product idea needed”?  If a product or service already exists in the market, then your products must truly be better, cheaper, or more convenient to be successful. And in some cases, it would need to be better and cheaper to catch the consumers’ attention.

When considering this question even further – in terms of production, quality and sustainability – you can easily determine if the product or service is deserving of the required resources.

Step 2:  Think beyond your lifetime

Some of the most socially responsible and successful companies look out 20 – 30 years before commercializing a product.  They may over-engineer a product, far beyond the initial scope, in order to open the way for future revisions or adjustments.  For example, an architect may design a project making use of reclaimed materials and energy-generating materials in anticipation of future advancements and needs. 

Step 3:  You are a resource too

When considering product success and sustainability, you need to think beyond the actual materials that will be required.  You need to ask yourself, “How committed am I to this idea?  Will I be as excited and passionate about this product in 5 years as I am today”?  Personal sustainability can no be underestimated because your idea’s success will need you year after year

Step 4:  Happiness counts

Some ideas may be difficult to measure in terms of social responsibility.  For example, how would the launch of another dermal filler be considered “good for the people”?  So instead, some projects – like amusement parks or comic books – should be measured in how much happiness will result from their use. 

If an idea doesn’t pass the social responsibility test, then run it through the “happiness quotient”.  Will your product or service bring more happiness and joy to the world?  If not, then scrap the idea.

Step 5:  The buck stops here

One of the hardest parts of evaluating an idea is assigning a dollar amount to our vision.  It has been proven that there is a direct correlation between a project’s profitability and it’s sustainability.   While some products make a boatload of money over 6 months and then disappear (think Pet Rock…), the ideas most of us have are those with real legs that will be profitable year after year.  Do the financials, understand your profit potential and evaluate your risks. 

Now go innovate!

Have You Ever Heard of the Park Avenue Potato Peeler?

Have you ever heard of the Park Avenue Potato Peeler? 

His name was Joe Ades.  He died in 2009 but his story is inspiring.

Joe stood on a New York City street corner in a $1,000 suit and was often observed absorbed in the joy of selling $5 potato peelers. People bought peelers as fast as the old man could pull them out of the box. 

Why did they do this? What was the pull of a $5 potato peeler?

Turns out, it had little to do with the potato peeler and everything to do with Joe. 

Joe put on a daily show with his potato peeling demonstration. People bought his potato peelers because they liked his energy and by purchasing a peeler, they usually felt like they were gaining a bit of that magnetic energy for themselves. They walked away empowered by that sense of passion and excitement. 

I read his story, and others like it, when I want to be inspired.

I read it not because I long to be a potato peeler salesman or think I have to peddle potato peelers to be successful. I read it because it says to me that anything is possible with a little inspiration.  Potato peelers aren’t sexy. They aren’t even that useful. So if that worked for Joe, I could possibly make my passion work for me.

You can sell yourself better when you are passionate about something and excited about it. Finding comprehensive sites like this one, reading stories of inspirational people, possibly working with a mentor or a coach, and doing things like networking, can often help you with that inspiration and confidence you need to effectively sell yourself into the job/career you want. You might even talk someone into creating that job for you or helping you out along the way. 

So I challenge you: If a $5 potato peeler salesman can do it, why can’t you?

Wealth Enhancement: Build Your Portfolio

As a physician, is your wealth manager asking you the right questions to manage your investment portfolio?

In a previous post I discussed the most important step in getting your financial life in order—and that’s to determine exactly what your goals are. Everything you do falls into place and has a purpose based upon your financial goals.

Then, before actually building wealth you need to protect what you already have and proactively protect what you will have through appropriate asset protection and insurance planning. 

Only after you’ve done that can you focus on building your wealth to achieve the goals you’ve set.

Wealth enhancement can be broken down into 2 areas: investment portfolio management and retirement planning.

One of the things that irks me about most financial advisors is that they dump their clients money into a mishmash of investments without any sense of purpose or figuring out how much risk you really need to take in order to achieve your goals. They also typically look at investments in isolation to the rest of the wealth enhancement process, and that’s a mistake.

So what are the questions you or your advisor need to answer before implementing a wealth building strategy?

Here’s a start:

1. How much risk are you able to take in your investments?
2. How much risk are you willing to take in your investments?
3. How much risk do you NEED to take in your investments to achieve your retirement goals? (This is THE most important question)
4. What is the proper mix of investments (asset allocation) that meets your ability, willingness, and need to take to risk?
5. How will you change your asset allocation as your age and as your life circumstances change?
6. How do you properly diversify an investment portfolio?
7. What specific investment products do you need?
8. What specific investment products should you avoid? (This is just as important as determining what you need)
9. How do you minimize taxes in your portfolio?
10. How much do you need to save to meet your financial goals in retirement?
11. What are the chances that you will meet your retirement goals?
12. What options do you have if you cannot meet your ideal retirement goals?
13. How do minimize the chance of outliving your money? (This is THE ultimate goal of any financial plan)
14. How does inflation impact my future spending and how does that effect my savings rate and asset allocation?
15. How do I allocate investments across different accounts?
16. What is the role of annuities, and do you need an annuity?
17. Which type of retirement accounts are appropriate for me (IRA, SEP IRA, solo 401k, etc.)?
18. Should I invest money in Roth accounts or traditional accounts?
19. When should I take Social Security?
20. Do I need long term care insurance and if so how much and what type?

As you can see your financial plan is not just about investments It’s about integrating your investments with the other critical parts of wealth enhancement and ultimately your comprehensive wealth management plan.

The Vaccine Scare + Lawyers

Are lawyers looking to sue drug companies behind for the bogus vaccine autism study?

There's a lot of news about Dr. Andrew Wakefield and the dirty vaccine study.

Here's part of a  CNN story. What I find most disturbing is a sentence that I've bolded at the end.

Vaccination rates dropped sharply in Britain after its publication, falling as low as 80% by 2004. Measles cases have gone up sharply in the ensuing years.

In the United States, more cases of measles were reported in 2008 than in any other year since 1997, according to the Centers for Disease Control and Prevention. More than 90% of those infected had not been vaccinated or their vaccination status was unknown, the CDC reported.

"But perhaps as important as the scare's effect on infectious disease is the energy, emotion and money that have been diverted away from efforts to understand the real causes of autism and how to help children and families who live with it," the BMJ editorial states.

Wakefield has been unable to reproduce his results in the face of criticism, and other researchers have been unable to match them.

Most of his co-authors withdrew their names from the study in 2004 after learning he had had been paid by a law firm that intended to sue vaccine manufacturers -- a serious conflict of interest he failed to disclose...

...According to BMJ, Wakefield received more than 435,000 pounds ($674,000) from the lawyers.

A law firm that intended to sue vaccine manufacturers paid the doc almost seven hundred thousand dollars to fund a study so that they could begin suing manufacturers? This may be the most cynical ambulance-chasing I've ever heard of.

Physician Poetry

By Dr. Jon Wolston

“Bitch is... we’re all close.”

When I heard a patient speak those words years ago, something happened to me that I still don’t fully understand. I felt like I had just been bestowed a gift in that moment, a gift that had to somehow remain unspoken about between us, but that nevertheless deserved to be acknowledged more widely somehow and eventually recognized publicly in some sense.

My outpatient practice began to take on an added dimension of “word mining” so to speak. The enduring value of certain words in and of themselves seemed to blossom overnight, yet the nature of their power remained mysterious to me. I couldn’t deny the potency of this experience, but I was still at a loss as to how to account for it except that it reflected some aspect of an intimate moment.

Eventually I learned about the tradition of “found poetry” and began to write what I heard in poetic format. I looked into poetry therapy as an adjunctive treatment modality, because I could sense its transformational heft. The National Association for Poetry Therapy is a wonderful organization, highly recommended, but it still wasn’t quite what I was after. Meanwhile, the poems continued to appear. Would they continue to emerge or would they mysteriously wane, like so many of the other things we hold precious? In a way I had difficulty claiming sole authorship. It seemed like the intimate moment was the author and I the transcriber.

Fortunately, I signed up for Dr. Julie Silver’s course in 2007, which was a godsend. Here were established authors of all stripes with tales to tell, professionals from all facets of the publishing world, and bemused newbies opening to the power of words. Julie helped me accept that I was evolving into a physician-writer and that I had good company among other emerging practitioners of this art. I’ve enjoyed keeping in touch with many of the participants since. One lasting understanding that I gained was that any book you see reflects the work of many different individuals, not just the author. Maybe this is a lesson of particular value to physicians.

Soon I began to attend all the poetry readings I could muster in my hometown, dragging friends along whenever possible. I met some inspiring poets, particularly on the nearby Brown campus, and corresponded with those who struck a chord and were kind enough to respond to me. I joined the writing group at the venerable Providence Athenaeum, an invaluable source of support and former hangout of Edgar Allen Poe. I started compiling first email lists and later blogs to send out poems for critique. Readings came by invitation. My favorite is probably the Super Bowl halftime reading my son Chris requested. You had to be there.

With the help of my good friend and publisher Bill Connell, I put together a manuscript of a poetry collection, “Paradise Root-stock,” printed in April 2008 . Bill’s advice was, “Publish when you feel like you have a certain ‘body of work’ that you’d like to represent.” In this collection I look to capture the sense of awe I still feel about where this all came from. The process still mystifies me. The title comes from a Galway Kinnell poem called “The Stone Table.” He names the most common apple-tree cultivar in New England as emblematic of his tenacity in the face of our notoriously tough growing conditions.  The title also alludes to what is probably my favorite poem in the collection, called “Nor’easter”:

     Poems are windfall
     of the orchards of my soul. . .
     some bruised some glowing,

     all with secret seeds
     ready to be swallowed up
     when God is hungry.

In hindsight, my friend the historian Dr. Doug McVicar was also a big help in getting PR-S into print. He issued a “dare” in 2007 to see which one of us would publish first! I think physicians thrive on healthy competition. If you’re feeling a little stuck with your writing, consider old-fashioned dares.

Four of the poems in PR-S were selected by the Poetry Society of New Hampshire for inclusion in their 2010 Poets’ Guide:More Places, More Poets. In doing promotion, I found that smaller independent bookstores love to have you read for them to help draw business. They are also more likely to be interested in stocking your poetry book afterwards than a chain or large bookstore would. Two of my all-time favorite bookstores: http://www.lexingtonbooksandco.com in Virginia and http://www.bayswaterbooks.com in New Hampshire. Both these wonderful venues allow an intimacy to develop, on account of their size, that is distinctive, and particularly conducive to poetry readings.

For physicians interested in developing as writers, Dr. Julie Silver’s Harvard course is invaluable and highly recommended.

About: Dr. Jon Wolston is a psychiatrist who transitioned to retirement by finding unexpected pleasure and meaning in writing poetry and publishing it, both in print (“Paradise Root-stock” 2008) and online at http://jonwolston.wordpress.com.

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Foreclosure Limited Partnerships

Taking advantage of the housing market with forclosure limited partnerships.

In my recent posts, I commented on how buying and selling foreclosures is probably the best way to take advantage of the depressed real estate market, due to the deeply discounted properties that you can purchase at foreclosure auctions. However, I also warned that such auctions are potentially hazardous to the financial and gastric health of the inexperienced investor.  

I believe that for most of us, it makes a lot more sense to become a passive investor in a limited partnership that specializes in these types of properties. The first set of reasons for this is a reflection on us as busy physicians. Between your practice and family obligations, you most likely will not have the time, and possibly energy to do all the research necessary to successfully purchase at a foreclosure auction. Also, many of our investment histories are littered with less than optimal outcomes, especially when we have become involved with investment vehicles that we are not totally familiar and comfortable with.

The second set of reasons focuses on the foreclosure auction process itself. Before even attending such an auction, you have to research public records to find the target properties and check title. Then at least a cursory inspection of the properties you might be interested is a must, which would include an estimation of the cost of any required rehab and fix-up. Also, you must analyze the local market and neighborhood to assess the current market value of the target properties.  Now you're actually at the auction, where you will be bidding against professionals that have a vested interest in you, as a newcomer, not succeeding. Assuming you are able to purchase a property at approximately the price you had in mind, and that you have access to cash funds or accessible lines of credit, you are now a property owner.

If your plan is to flip this property for a relatively quick profit, you must have the necessary rehab work done, which frequently concentrates on cosmetic items.  When completed, you place the property on the market, either as a "for sale by owner", or through a realtor.  Hopefully, you purchased the property at a marked discount to current market value so you can re-list it at a price that is still sufficiently below comparable properties, to allow a quick re-sale.

If this seems like a lot of time and work, it is. There are also a lot of potential mine fields in this scenario, such as: buying a property that has too many hidden rehab costs, paying too much for the property, not having access to lines of credit so you have to spend all your available cash on one property. I'm convinced that this is not a field that I personally feel comfortable playing in. I would rather try to accomplish the same investment goal by investing with groups that literally do this for a living.

After researching this issue, I felt most comfortable with a group out of Northern California - Praxis Capital. I was impressed enough that I become an equity participant in their syndication. They focus on single family residences in Northern California that are primarily bank owned (REO's). They also get involved in short sales, trustee auctions and bankruptcy liquidations. Their average purchase price is $ 219,000 and the average re-sale price is $ 293,000. The average sale price is 34% above the purchase price, which can be as low as 20% of the market peak values. The average time from purchase to sale is 91 days, and they average 12 property purchases per month.

The Praxis principals have successfully managed 26 partnerships, and have purchased over 150 properties since March 2009. They have over 21 years experience in foreclosure auctions. The partnerships have access to several lines of credit, which allows them to leverage multiple properties, which in turn increases the profit margin return to the investors. One of their recently closed funds boasted an average annual return of 34.53% to the investors. 

The limited partnership focuses on foreclosures (which I believe is the property type with the greatest profit potential), concentrates on a buy and sell strategy (which I feel best suits today's real estate market) and works in Northern California (one of the prime markets that will continue to do well in today and tomorrow's market). The Praxis group has extensive experience in foreclosure auctions, property valuations and property re-sales. After a holding period, the investor has the ability to withdraw some or all of their investment. But what I like most about this particular partnership is their transparency. You can speak to the partnership principals - really! In addition to their periodic P & L reports, they hold quarterly conference calls with the entire limited partnership.  

If you would like more information on this partnership, you can contact me, contact their Investor Relations Director - Sherri Haskell (415-722-4849 - sherri@praxcap.com) and check out their website.

Physicians: Is Management Consulting For You?

Consulting is a great option for physicians, whether it is for a boutique or “Big Four” firm… but one caveat:  know what you’re signing up for.

I know of which I speak. For a number of years I was one of the road-warriors that worked for a Big Four firm – in my case, Accenture (formerly Andersen Consulting), as a Senior Change Management Consultant. It was an incredible, exhausting career – with both big highs, and big lows.

I saw a posting the other day for a “Physician Management Consultant”, and it made me think. The location of the role was stated as “Virtual – Candidates can be located anywhere near a major airport within the Continental U.S.”. And did this bring back memories of my life as a management consultant, oh yes.

When I joined Accenture, I was working hard in graduate school, getting my degree in clinical psychology. When the interest came from them to recruit me, I thought “why not”, what would I have to lose?  I thought I would try management consulting for 6 months to a year (which was as long as I could convince them to hold my place in the Ph.D. program), was sure that I wouldn’t enjoy it, and was convinced I’d be back completing my degree by the following  winter. Well, that didn’t actually happen.  Management consulting turned out to be more interesting than I expected… more rewarding financially than graduate school or an entry level role for a Ph.D. clinician (go figure!)… and more exciting, more fun.  So I stayed … and learned things on the ground in global organizations that I never would have gained by staying in a clinical career. It was fascinating work - and exhausting, demanding work too… physically, emotionally, and intellectually. During my tenure I learned things about myself, about how the corporate world works, about priorities and “bottom-lines”, and about how people function professionally and personally in the context of their work.

In my role as a physician executive coach I’ve worked with docs who have decided they wanted to leave the clinical world to go work for one of the big consulting firms. They may be attracted by the possibility of utilizing their expertise in a bigger way, by the credibility of affiliating themselves with a “top firm”, by the glamour that a consulting role seems to hold. I support whatever non-clinical path my clients feel is the right fit for them, but I do feel strongly about giving my docs a “reality-check” when it comes to the lifestyle and demands associated with management consulting.  I’ve been there, I’ve done that.  Until you’ve been in the trenches it is hard to know what it is really like. 

So for any of you physicians interested in a non-clinical career in consulting, here are my thoughts: I call it “Management Consulting 101” or simply, “Know What You’re Getting Into”.

Expectations

The expectations for consultants can be both overt (shared in hiring/orientation) or more subtle - inherently part of the culture and used to assess whether you as an individual are both “cut out for” consulting or will be successful in the firm. 

Regardless of whether it is a large firm or smaller, boutique outfit, these expectations are pretty much the same: 

• Be willing to go anywhere, anytime – the clients’ needs always come first
• You must have complete mobility – and be highly adaptable to new situations, new teams, new problems to solve, and new locations
• You must deal well with sharp learning curves and high expectations from clients – you must add value from the moment you arrive on a new client site, and hit the ground running
• You must have the ability to collaborate on larger, mixed consultant/client teams, and be skilled in managing conflict/challenges that arise
• You must have incredibly high levels of professionalism, communication and accountability, and the ability to deliver results, and to truly “team” (i.e., trust your team-mates, delegate, work together for a common goal, stay accountable and meet expected outcomes)

In my experience these are things that most physicians who choose consulting either have a natural affinity for, or are able to get their arms around and excel in. However, there are some who have gotten tripped up over their lack of awareness of these expectations, or their lack of preparation / skill in these areas. The good news is that these are things that can be learned, either on the ground (although this may make your learning curve a little steeper and longer), or with some specialized, up-front skill development while still in clinical practice. The key is knowing what the expectations are for consulting work, and doing some introspective work to assess yourself on both your interest and skill level in these areas. Then find someone who can help you develop – either learning from a colleague who is  in consulting already, or finding a mentor who will help you walk through the steps, working with a coach, or getting feedback from a supportive peer.

Lifestyle

One of the hardest things in consulting is the lifestyle. Many docs I work with are unclear about how the work is done, and expect that they will be able to conduct their consulting projects within their home area, and travel only occasionally. Unless you live in a major metropolitan area that houses the headquarters of the kinds of organizations that you want to specialize in (e.g., Pharma, Biotech, etc.), and there is a demand for projects in your area, you will be on the road. This is one thing when you are young, enthusiastic, and have no family ties to keep you in one place. Then consulting, and the significant travel it requires, is exciting and an incredible opportunity to travel the world for work. 

But when you have a family, or ties to one geographic location, the option of consulting work is a little more complicated. The truth of the matter is that you go where the work is. It is a fact of life, and one that was well-validated by the online posting for the Physician Consultant that I mentioned above.

So a reality check about the consulting lifestyle?

• Get used to being a “road warrior” – remember that movie with George Clooney called “Up In The Air”?  That was my life, and is the life of many, many management consultants.  It is more typical than not. 
• You will have to spend a lot of time away from your home location and family – The majority of my consulting life I was out-of-town Mondays through Thursdays/Fridays, depending on whether the client demanded that I be “in office” on Fridays.  Most consultants do the same thing.  If you have a very forgiving client, or belong to a firm that highly values the personal needs of their employees, you may be able to do a Monday-Wednesday and work virtually Thursday and Friday, or some combination thereof.  But don’t count on it.
• Be “on call” to fly wherever, whenever – again, the clients’ needs come first – if they need you on a plane at 6am the next morning, get your bag packed, and arrive at the airport at 5:00am with a smile.
• Get to know, and love, your home airport – once you know the routines of your home airport it will be as familiar to you as your own house.  Get to know your regular gate crew (if you’re flying the same airline most of the time, which you should), they will be nice to you, which is always a good thing when you’re trying to upgrade, standby, or get priority seating.
• Get to love hotels – this too is a reality of the consulting lifestyle … while often fun at first, hotels become just that, hotels, after a while.  If you can maintain a routine and take advantage of their perks (i.e., gyms, room service, hotel points, etc.), you will start to find your own rhythm to make yourself at home.
• Long hours, high client demands – you will be adding value from the moment you arrive on-site to the moment you leave (consultant’s rule of thumb? You should always arrive before your client, and leave after them).  You are your bill-rate, and the client doesn’t forget that.  You can’t either.
• Changing teams – don’t get attached!  One thing that is true is that you can be working with a team of people for months, and then all of a sudden have the team disbanded and the project ended at the need of the client.  Another rule of thumb – don’t get too attached to any one project team, or any one organization.  Before you know it, you’re flying to another city to be part of another team.

Now I don’t want to give the impression that management consulting is all hard and difficult. There are elements to it that are incredible and unique – you will never do work like it. Some of the reasons why people do it, and find it incredibly rewarding (including me!):

• You have the opportunity to work on exciting teams, doing exciting, cutting-edge work:  Everything that is done in consulting work is the latest and greatest. You will have the chance to meet and work with incredibly smart professionals, who are passionate and interested in the same things you are. You will be learning the newest methodologies, technologies, and processes in your given field, and you will be able to apply your medical knowledge/experience in a way that supports your clients’/projects’ efforts and success. You will see tangible results of your work in finite time periods.
• You will be able to travel internationally, collaborating with global teams/clients: This is an incredible learning opportunity, both as a professional and as a human being. One of my favorite parts of my work at Accenture was collaborating with colleagues in Sweden, Japan, Australia, and Germany (to name a few) on different clients/projects, to solve different problems. 
• Air miles! This starts to matter. Some of the best vacations my husband and I took were during my tenure with Accenture, since all of those hotel points and air miles start to rack up and provide the wonderful opportunity for free international travel (China!  Australia! Greece! Spain! Italy!) and free hotel stays. Not too shabby.
• Interesting, changing work:  One of the best things about management consulting is that it never gets dull. Your intellectual and “EQ” (Emotional Intelligence) abilities are constantly put to the test, as you are required to solve your clients’ problems in different ways, with different people, and in different organizational cultures, on a regular basis. If you like change and variety, then consulting work provides that.  If you are a natural problem-solver, like many physicians, you will feel right at home with the challenges that your clients provide you with. Consulting is not for everybody, but it could very well be for you. Only you can decide that.

For further reading on management consulting as a non-clinical career choice, I recommend the book “Management Consulting Today and Tomorrow:  Perspectives and Advice from 27 Leading World Experts” (2009, by Larry Greiner and Flemming Poulfelt).

Another very good resource was written by a consultant, titled: “How to Get Into the Top Consulting Firms: A Surefire Case Interview Method” (2009, by Tim Darling). It provides not only a realistic overview of the consulting lifestyle (who succeeds, what it’s like, what you need), but also provides a primer for making yourself a desirable candidate (how to succeed in a problem-solving interview, resume prep, etc.). I highly recommend this book if you’re even thinking about consulting as a non-clinical option.