Michael E. Gerber - The E-Myth Physician: Why Most Medical Practices Don’t Work and What to Do About It

The E-MYTH
Physician

WHY MOST MEDICAL
PRACTICES DONT WORK
AND WHAT TO DO ABOUT IT

MICHAEL E. GERBER

The basic difference between an ordinary man
and a warrior is that a warrior takes everything
as a challenge while an ordinary man takes
everything either as a blessing or a curse.

D ON J UAN IN T ALES OF P OWER
C ARLOS C ASTANEDA

Whenever anything is being accomplished,
it is being done... by a monomaniac with a mission.

P. D RUCKER, QUOTED IN
R IPPLES FROM THE Z AMBESI, BY E RNESTO S IROLLI

CONTENTS

ix

xv

The Story of Keith and Susan

On the Subject of Money

On the Subject of Planning

On the Subject of Management

On the Subject of People

On the Subject of Employee Doctors

On the Subject of Estimating

On the Subject of Patients

On the Subject of Growth

On the Subject of Change

On the Subject of Time

On the Subject of Work

The Story of Dr. Sandy

On the Subject of Taking Action

I am not a Doctor, though I have helped dozens of Doctors reinvent their medical practices over the past 25 years.

Ive learned there are two kinds of Doctors. In the first category are Doctors who own their practice. Theyre slogging through each day, putting out fires, trying to support their family. Although these Doctors often have cloudy vision, they are in fact visionaries. In the second category are Doctors who lack or have abandoned such vision. They work for the HMOs and the insurance companies. This book will have its greatest appeal to the first group.

Most medical practices today are failingnot necessarily going out of business (though many are doing that every day) but failing to fulfill the potential the Doctor envisioned in those halcyon days of medical school. Most Doctors who own their own practice dont own a true business but a job... doing it, doing it, doing it... hoping like hell to get some time off, but never figuring out how to get their practice to run without them. Thats where E-Myth comes in.

I like to view myself as a thinker, even a dreamer. Yes, I like to do things, but before I jump into a project, I like to think it through and figure out the best way to do it. I try to see the finished product in my minds eye. I imagine the impossible, then try to figure out how the impossible can become the possible. And how the possible can become reality.

Over the years, Ive made it my business to study how things work and how people workspecifically, how things and people work best together to produce optimum results, and how to create an organization that can do great things and achieve results better than any other organization.

The end product has been a series of books Ive authoredThe E-Myth booksas well as a company, E-Myth Worldwide, which I founded in 1977. E-Myth Worldwide has helped thousands of small business ownersincluding many Doctorsreinvent the way they do business by (1) rethinking the purpose of their business and (2) imagining how it could fulfill that purpose in innovative ways.

This book is about how to produce the best results as a real-world Doctor in the development, expansion, and liberation of your medical company. In the process, you will come to understand what the practice of medicineas a businessis and what it isnt.

Although this book is small, its about big ideas that may at first overwhelm you. Thats not because Im so smart, but rather because the way most Doctors run their practice is light-years away from the recommendations in this book.

My aim is to help you begin the exciting process of transforming the way you do business as a medical practitioner. As such, Im confident that The E-Myth Physician could well be the most important book on the practice of medicine as a business youll ever read.

Unlike other books on this subject, I dont try to tell you how to do your work as a Doctor; you already know how to do that. Rather, I strive to offer insights into how great businesspeople think, whether they are Doctors or not.

Most Doctors dont think of themselves as businesspeopleand thats the problem. Because thats exactly what they have to be to own a practice. In fact, most practices fail to fulfill their potential not because of the Doctors medical skills, or because of whats going on outside the medical practice, such as managed care, defiant insurers, and increased costs. Rather they fail because Doctors are not prepared for what is about to happen to them. They are simply unprepared for the business of medicine. Victims of an entrepreneurial seizure, they believe that because they understand how to do the technical workthe work of a Doctorthey understand how to build a successful business that does that work.

The truth is that learning how to be a Doctor does not prepare you to develop a successful medical practice. Knowing how a practice works best has little to do with knowing how a Doctor works best.

In fact, its the chasm between being a Doctor and an entrepreneur (a true businessperson) that is the primary cause of the malaise, disaffection, and frustration experienced by most Doctors who own their own practice.

No matter how much the Doctor knows about the work of doctoring, none of that expertise is in itself sufficient to build a successful practice, business, or enterprise. Its only the beginning.

The good news, Doctor, is that you can avoid these pitfalls. Despite what you may think about patients, insurance companies, and HMOs trying to destroy your practice, the E-Myth philosophy, when applied to your practice, will transform it into a flourishing business and an extraordinary enterpriseto the degree you want it to.

Im convinced that although the E-Myth philosophy is a new way of thinking for most Doctors, they must adopt it if their practice is to flourish. I call this new perspective Strategic Thinking, as opposed to Tactical Thinking.

In Strategic Thinking, also called Systems Thinking, you, the Doctor, will begin to think about your entire practicethe broad scope of itinstead of just its individual parts. You will begin to see the End Game (perhaps for the first time) rather than just the day-to-day routine in which you and your employees are continually immersedthe work I call doing it, doing it, doing it.

Understanding Strategic Thinking will enable you to create a practice that becomes a successful business, with the potential to flourish as an even more successful enterprise. But in order for you to accomplish this, your practice, your business, and certainly your enterprise must work apart from you instead of because of you.

The E-Myth philosophy says that a highly successful medical practice can grow into a highly successful medical business, which in turn can become the foundation for an inordinately successful medical enterprise that works apart from the Doctor-owner instead of because of the Doctor-owner.

According to the E-Myth, the key to transforming your practiceand your lifeis to grasp the profound difference between going to work on your practice (Systems Thinker) and going to work in your practice (Tactical Thinker). Its the difference between going to work on your practice as an entrepreneur and going to work in your practice as a Doctor.

The two are not mutually exclusive. In fact, they are essential to each other. The problem with most medical practices is that the Systems Thinkerthe entrepreneuris completely absent. And so is the vision.