Eyeworld

OPHTHALMOLOGY BUSINESS 72 April 2015 by John B. Pinto Our accustomed, affluent status quo is doomed for myriad reasons— the competitive rise of the rest of the world, political fatigue in the industrial west, erratic but generally rising energy costs, the accelerat- ing substitution of technology for human labor, a natural pullback in the U.S. economy as boomers retire, and the long-recognized reality that we have vastly overshot the mark on what can be affordably spent as a nation on healthcare services. And that's before even consid- ering the galloping pace at which private specialty practices will be absorbed into deep-pocketed region- al health systems, with much of the profession's accustomed ancillary profits being shifted to institutional bottom lines. The era of ophthalmic afflu- ence will pass for all but the most entrepreneurial providers. These few physicians are now climbing up the industrial curve by employing many associate doctors or developing technologies to provide more care with fewer resources. Your person- al ophthalmic income will still be based on your personal merit and work intensity, but the ophthalmic baseline income of the future will be somewhat lower than it is today. Editors' note: This month's column by John Pinto is excerpted from his forth- coming book Simple: The Inner Game of Ophthalmic Practice Success, which will be available shortly from ASCRS•ASOA. "There are but two tragedies in life. One is one's inability to attain one's heart's desire. The other is to have it." –Sir Francis Bacon O phthalmology may be an elegant profession, but it is not in the least simple. Eyecare practitioners are wicked smart. They have a tolerance for—and more than that, are drawn to—things that are com- plex. Why else would a procedure like cataract surgery with essentially perfect outcomes since the turn of the century still be such an active sphere of ongoing innovation and elaboration? These intellectually gratifying clinical and surgical complexities (that at least stand to marginally improve patient outcomes) are unfortunately matched by galloping complexities that won't add value to patients in the years ahead: • Coding and documentation changes are taking time away from patient care and caring, and the chase to document mean- ingful use is probably shortening administrator lifespans • Local hospital/provider consoli- dation and competitive encroach- ment threatens the independence of nearly every private practice in America today • Third-party payer reform included under the Affordable Care Act is making everyone a bit crazy and a lot insecure As unaccustomed as it is in ophthalmology, "simple" is at least a partial antidote for everything that makes ophthalmic practice so vexing. "Simple" mitigates to some degree a world of increasing elabora- tion. Simplicity includes: • Taking pride in the smallest, most time-and-motion-efficient office facilities you can get by with instead of the largest facilities you can afford • Employing a small, long-ten- ured, crack team of cross-trained support staff rather than a fleet of newbies • Eliminating all patient services and conversations that don't add value • Getting physically fit and mental- ly clear enough to breeze through the extra patients needed to sustain practice cash flow as fees stagnate • Providing such great customer service that external marketing is no longer needed • Simplifying call coverage to every possible degree • Changing your attire to scrubs to reduce costs while increasing professional appearance • Removing all the clutter from your office space • Arranging simple appointment templates with shorts and longs, rather than fractionating into a dozen or more appointment types that nobody at the front desk can keep straight • Avoiding expensive trips down the rabbit hole to try out yet another "sure-fire" practice adjunct (read: facial skin resurfacing, hair remov- al, medi-spas, hearing aid centers, and the like) • Working 40 hours a week in 4 days instead of 5 • Taking the paperless office all the way, not just as far as electronic health records • Making time to enjoy a midday run, lunch out, or that long- lost escape to the golf course on Wednesday afternoon • Living closer to your office to save commuting time • Even changing your personal lifestyle so that you own your practice instead of your practice owning you As a management consultant, I am a curator of practical things that work. Of necessity, I ignore much of that which is new and fashionable and exciting. Most new business ideas, like most first thoughts in science and medicine and politics and archi- tecture, are bunkum. We humans, in the main, are an unwise species. Baked in the cake is a predilection to ignore data, avoid difficult conversa- tions, and follow imprudent leaders. This happens as much within the smallest ophthalmology practice as it does in the broader world. Here in Eyeland, we have all been happily habituated to relative stability, both as countrymen of a nation at the top of the heap since the end of World War II and as participants in the prosperous field of ophthalmology. This is not likely to last. An ophthalmic reality check— and the search for simple

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