FEB 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/274531

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Page 97 of 114

"Aim higher in case you fall short." –Suzanne Collins "If you don't know where you are going, y ou'll end up someplace else." – Yogi Berra "The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low and achieving our mark." –Michelangelo Buonarroti A s I write this, surgeons across America are wind- ing down their year and heading off to family celebrations. By the time you read this column, you've proba- bly been asked in the last couple of months by a well-intended parent or competitive sibling, "So, how's it going? What are your plans for the future?" Chances are, you answered these questions by rote—and a bit defensively—just as you have since you were a college sophomore. "Oh, I don't know. It was a pretty good year. If I can have another one like it in 2014 I'll be happy. Beyond that, we'll see." That's a perfectly acceptable white lie to tell your relatives, but a complete disservice to your profes- sional and business life if you're a practice owner. If you run even the smallest practice, success obliges that you look yourself in the mirror at least annually and get real about the future. Where to start? This business and personal self-examination is something you can divide and conquer. There are five logical domains, which I discuss below. Each of these flows from one to the other. You can't effectively decide on strategic or tactical goals for your practice until you have clarified your per- sonal and financial goals—or until you and any fellow surgeons you practice with have developed a sufficiently intimate relationship to be able to align your interests as partners. Personal goals Take a deep breath. This is the hard- est question: What do you want to see, have, do, be, experience, and give away in your remaining sentient, physically active years? The average ophthalmologist is now a male in his 50s. Imagine that's you today. Here's the count- down: You will practice for about another decade and transit about 50,000 remaining patient visits. You have perhaps 20 or 30, or if you're very lucky 40, years left to walk without a cane, hear without an aid, or speak without having someone younger remind you what you were talking about. You have already worked out how to earn a living and live within your earnings. But if your life is not yet meaningful—and many surgeons in their 50s tell me they are still not yet living meaning- ful lives—how will you make it so? You have already used up more years than remain. How is your work/life balance? When will you retire? More impor- tantly, what will you retire to? What are the values that help you priori- tize how you will spend the fast- ebbing balance of your life? When I visit with clients, these personal questions are often much more difficult to answer than those related to the science or business affairs of medicine. And yet, these are the questions that must be answered before you can frame up and intentionally pursue a coherent professional life. Personal financial goals In the context of your personal goals, which may be major or mod- est, are you on track with earnings? Are your earnings and savings aligned with your lifestyle costs before and after retirement? If these are not yet aligned (and chances are, you need more income to reach your personal goals—this is America, after all), there should be a feedback loop to the practice's strategic and tactical dimensions, which will allow greater active or passive earn- ings. Once you are clear about your personal goals, the associated finan- cial details can be reduced to very plain, ABC terms. You or someone you know may have a situation like this: • Dr. Smith is 55; she wants to retire at 65. • Dr. Smith was a bit late in making financial plans, and it appears that in 10 years she will be $500,000 short of the funds she needs to retire. • After accounting for a modest appreciation of her current and future savings, Dr. Smith's CPA determines that she needs to earn (and save) an extra $400,000 over the next decade. • Dr. Smith needs to earn an extra $40,000 every year for 10 years. • Since most practice costs are fixed, there is only a 40% variable over- h ead load on every incremental dollar she brings into the practice, so to clear $40,000 a year, she needs to generate about $67,000 in extra collections. • She collects an average of $160 in net revenue per patient visit. • At $160/patient visit, that comes to 419 extra visits for the year. A fter accounting for vacations and meetings, Dr. Smith only needs to transit an extra nine patients per week to meet her goals. Transpersonal goals U nless you are in solo practice, your personal and personal financial goals must be coordinated with, and then remain in sync with, your partners. Here are some examples of how partners get out of sync with each other: • By skipping meetings and then complaining about board decisions • By voting for their personal inter- ests rather than the best interests of the practice • By voting in the board room, and then undermining the board's final decision among support staff because it goes against the way they voted • By taking excess personal time after everyone has agreed that partners are limited to six weeks off each year • By unreasonably writing off refraction and testing charges, pushing more overhead costs to the partners • By pressuring colleagues to pur- chase a non-essential new tech- nology for the clinic, even when the practice's finances are tight • By excessively competing with the newest doctor to join the group, even if 15 years ago the senior partner cannibalized his schedule to give them a leg up Every practice board is different. Some lucky surgeons sing Kumbaya and share rotating partner dinners at each other's homes. Many more, a majority, frame up practical working relationships that fall short of close social friendships, but which still allow for effective teamwork. A EW Ophthalmology Business 95 by John B. Pinto The five sequential domains of your goals as an eye surgeon continued on page 96 F ebruary 2014 91-97 OB_EW February 2014-DL2_Layout 1 1/30/14 11:51 AM Page 95

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