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continued from page 17 record (on a 3" x 5" card) said all that was needed, tersely: "Left eye doing better." Twenty years ago, SOAP was sufficient on a full sheet of paper. In the future, the nexus of EHR, ICD-10, and progressively narrower payer care pathway algorithms will constrain today's youngest surgeons to an environment where a lot of medical decision making will result from artificial intelligence instead of the medical arts. Lay staff, to the extent that they have not been replaced by robotics, will be similarly directed by machines in their support of the doctor. Rather than fight this trend, embrace it, and harness technology that will soon be emerging from the most vanguard software providers to help you make and record faster clinical decisions, see more patients, and stay CMSsafe. 5. Provider harmony will take more work. Control equals happiness. And the private group practice of the future will almost certainly involve less control. So as an administrator or managing partner, you are going to have to work hard to preserve surgeon-owner happiness. From past study and observation, we know that surgeon happiness and collegial relations within a group set- ting correlates most closely with a surgeon's ability to earn an income that is significantly higher than his or her lifestyle costs. Under best-case scenarios, even the best mitigation efforts to respond to coming +/–15% top-line cuts will result in the typical partner in the typical practice receiving a 10-25% cut in income. Three mitigation strategies are essential in the coming era: • Surgeon-owners need to know that they—and their managers—are doing everything reasonably possible to preserve profitability. • Surgeon-owners need to double down on communication, especially frequent, face-to-face, boardlevel sessions, which go beyond the dry monthly economic statistics to explore each doctor's feelings about his/her present and projected earnings. • To the extent feasible, as an administrative or medical leader in your practice, you need to urge both owner and non-owner providers to plan ahead, taper their lifestyle costs, and get real about their retirement calculations before the most difficult revenue adjustments arrive. 6. From a "weak leader" to a "strong leader" model. In a mis- placed desire to avoid conflict, many group practices still operate with little more than a figurehead physician leader and the insistence on 100% consensus for all decisions. This was fine in the softball era of ophthalmology. In today's environment, where decisions are going to be tougher and come at you faster, a formal managing partner should be selected and empowered, even if there are only two practice owners. This leader's role is NOT to take over for the board, but to help assure that the board's will and policies are being briskly translated into action by the management team. 7. The shift from "any plan or even no plan works" to "we had better choose the right business plan." Most practices still go "bare" when it comes to writing a formal strategic business plan. They daisy chain from one tactical business opportunity to the next (Buy this laser! Hire this doctor! Open that satellite!) without the basic underpinning of a strategic context for their decisions. The smartest practices today are taking the time to discuss and formalize their long-term goals. In closing, and in response to the surgeon whose note to me kicked off this discussion, we are in the early stages of a profound phase shift in the business and profession of eyecare. The future environment will oblige more teamwork and less rugged individualism, more planning and less shoot-from-the-hip, more leadership (and good followership) and less freestyle management. OB Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979, with offices in San Diego. He can be contacted at 619-223-2233 or pintoinc@aol.com. 18 Ophthalmology Business • April 2013