EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/307191
by John B. Pinto
Avoid building or joining a practice larger
than you can thrive in and one day lead
"Your eyes are always
bigger than your stomach."
Confucius
A
s you can see from this
quote, Confucius, if not a
very
precise anatomist,
was exceptional at captur-
ing the basic, grasping nature of
mankind. It's handy, for the pur-
pose
of the discussion that follows,
that he used eyes in his metaphor.
Leadership obliges that you see
business opportunities and gauge
your
business appetites with clarity.
You want to be part of an organiza-
tion that's scaled to your personality
and ambitions. It's as frustrating for
an eye surgeon to build an organiza-
tion larger than his personal ener-
gies, commitment, or leadership
talents as it is for an ambitious oph-
thalmologist to be boxed in by a
too-small
practice.
Errors and misfits take different
forms in different settings:
• The soloist who builds a 15,000-
square-foot building (because he
so loved the process of design and
construction and assumed that his
practice would bloom) but who
doesn't have the energy or risk tol-
erance to build a practice of com-
parable scale.
• The large-practice surgeon who
feels lost in a crowd of partners
when he would really prefer to call
the shots all by himself.
• The doctor with real leadership
talent who works in a market
that's so competitive that building
a larger group is almost impossi-
ble.
The paradox of practice size
Remember that except for a few un-
usual, very large settings, practice
scale has little influence on the prof-
its flowing to a given doctor owner.
Indeed, because of the commonly
observed diseconomies and ineffi-
ciencies that can attend scale, I get a
lot of calls from surgeons in eight- to
12-doctor practices who start the
phone discussion by saying, "We
were doing so well with five doctors.
Profit margins were high, and man-
agers could understand and control
all of the moving parts. Now, profits
are down, confusion is up, and one
hand doesn't know what the other is
doing. What happened to us?"
The answer to the doctors'
lament, "What happened?" is best
visualized by a simple two-line
graph (Figure 1).
How can you know your own
boundaries, your own just-right
practice sweet spot? Here is a discus-
sion of eight simple determinants
that may help you decide if you're
better suited for a large or small
practice.
As you'll read, some surgeons
EW Ophthalmology Business
88
February 2011
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