If your medical practice were a patient, how would you rate its health? What would be your diagnosis? How would you develop a treatment plan?
These are good questions to ask, because you can learn a lot by thinking of your practice as a living organism, and applying the principles of holistic medicine to look carefully at how it functions, said Dick Thom, DDS, ND, a full clinical professor at National College of Natural Medicine, Portland, OR.
Just as everything you need to know to make an accurate medical diagnosis is within a patient, so everything you need to know about how to restore your practice to health is to be found within the practice itself. “Everything, and everyone, is talking to you. You just need to learn to listen.”
In addition to his own naturopathic practice, Dr. Thom and his colleague Mr. Andre Belanger run workshops called the Health of Business & the Business of Health, which teach physicians to use what they know about healing to assess and transform their own practices. Dr. Thom will be among the featured speakers at Heal Thy Practice: Transforming Primary Care, Holistic Primary Care‘s upcoming conference in Tucson, Oct. 31–Nov. 2.
According to Dr. Thom, in a healthy practice 50% of revenue should go to the practitioner(s), with the other 50% being overhead. The office atmosphere and management systems should be patient-friendly, engaging, and supportive of the core mission of helping people move from illness to real health. Moreover, a healthy practice should both exemplify and support a practitioner’s own commitment to health and healing.
Time & Money: The Vital Signs
How you spend your time and how the money circulates through your practice are two key parameters that need very careful monitoring.
“Do a time-study of your practice. Look closely at where, how, and on what you spend your time during a working day,” said Dr. Thom, who has developed time-assessment spreadsheets that help with this. From a business viewpoint, he divides practice time into 3 categories: revenue-generating time, necessary but non-revenue-generating time, and non-productive time.
In an ideal day, 80% of the time is spent on revenue-generating activities, 15% on necessary but non-revenue generating work, and 5% on non-productive ways. “If you’re spending 36–40% of your time in non-productive activities, it will kill your practice,” he said. Likewise too much “necessary” but non-revenue-generating activity also takes a toll.
A lot of lost time is due to poor management systems, but it may also reflect one’s personal preferences and aversions. You might be spending a lot more time than necessary on things you like (or don’t mind) doing, while neglecting less enjoyable but necessary aspects of the practice.
For example, Dr. Thom finds that many doctors drawn to holistic medicine love expanding their clinical knowledge. They spend much time, energy and money at seminars learning new skills, tracking the latest science, or otherwise enhancing their grasp of medicine. And they all but ignore the business side of practice.
This reflects a love of healing and distaste for the brass tacks of business. But in the rough and tumble world of fee for service, where most of holistic and naturopathic medicine is done, it’s the business chops that really need honing. “Learning more clinical skills won’t make your practice more successful. Look long and deeply at the business aspects.”
The Budget: Don’t Fudge It
Dr. Thom strongly recommends making a practice budget and studying the money flow the way you’d study a patient’s blood chemistry. “If you don’t have a budget, you won’t know what you need to do and what you need to avoid. You need to know where your money’s coming from and where it is going.”
“Statistically, 92% of all businesses fail because of lack of administration and lack of budgeting. Spending just one hour per week on budgeting and assessing your finances can make a huge difference. Take that one hour every Friday, and really look at the numbers.”
It’s not just about numbers, though. Like lab results, you need to know the story behind the numbers. That means looking carefully at what happens in your practice and why. It also means looking at your own ideas and attitudes about money. These may be unconscious but they govern our lives far more than we realize.
“A lot of people in health care are afraid to talk about wanting wealth and material well-being. But I believe there’s no shame in wanting a nice house, a well-off lifestyle, to be free from economic worries. Yet a lot of healers seem to hide this.”
If 50% of your practice revenue is not going to you, well, where is it going? And to whom? And why are they more deserving of the money you earn? If your revenue cannot provide a decent standard of living, how will you create new revenue? Once you get a handle on what’s actually happening, you can start looking at different models for change.
Redefining “Doctor,” Redefining “Patient”
Dr. Thom sees a physician’s primary role as teaching others how to heal themselves and live a healthy life. “I don’t focus on treating symptoms. I can help people understand why they have symptoms, but I’m not in the business of treating symptoms,” he says. “My job is really to help people find balance.”
Always ask, “Why?” Why is this happening? Why this problem in this patient? Why now? “There’s always a reason for symptoms. Your job as a doctor is to help people discover what that reason is.”
He believes strongly in educating patients on how to handle minor, acute problems themselves. “Shift them away from dependence on you and toward empowerment of themselves.”
Dr. Thom built his own practice around programs rather than specific services or treatments. His River of Health program is designed to help chronically ill people move toward health. It begins with some symptom management plus education and modeling of lifestyle change, then goes deeper into underlying etiologies by studying miasms, temperament, constitution, genetic predispositions. If a patient has been ill for a long time, this may take 2–3 years.
The Four Seasons of Health program involves quarterly seasonal wellness visits for people who are basically healthy but need periodic guidance. Life-Long Prevention involves tailored health maintenance visits once or twice per year.
“We need to change our patients’ understanding of why they come to us. I don’t want patients coming in only when they’re sick. I try to get them coming in every month. It is like a lesson plan.”
Position yourself as a wellness leader in your community, and let people know that you offer programs that can help them find their way toward health and wellness. If you have 300–400 patients interested in and committed to being well, and 50% of the revenue from these patients goes to you, you’ll make a very good living, he said. You’ll also enjoy your practice a lot more.
The Human Touch
The ultimate “deliverable” of your practice is in helping people move from illness to health, and that means you need to connect with the human element, the real person within each patient. “This is what we lost in conventional medicine. It is what people want, and we need to re-establish it.”
The most common complaints about medical visits are the waiting time, the feeling that doctors and staffers do not really care, and that doctors don’t listen. “If you don’t do the things that people hate about their other doctors, you’ll stand out as remarkable and your practice will grow.”
To this end, your waiting room should be an education room, an interesting place where patients can learn, connect with each other, and prepare for the visits. Make it a health resource room, a meditation room, anything but a cramped, poorly lit space full of angry people wasting time with year-old People magazines or watching “reality” TV. If your reception area is interesting, patients may not mind spending a little extra time there. They might even look forward to it.
Be attentive to your patients. “A study showed that if the doctor makes good eye contact and touches patients in a friendly but non forceful way, patients perceive that the doctor has spent a lot more time with them than the doctor actually did spend,” Dr. Thom said. “Remember that the first step toward healing is a smile and a deep breath.”