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By Douglas R. Turgeon, MDExcellence With an Edge: Practicing Medicine in a Competitive Environment By Michael Harris, MD Fire Starter Publishing Gulf Breeze, Fla. 2011, 207 pages ISBN: 978-0-9840794-9-0

AAOS Now

Published 7/1/2011

Running a business that cares for patients

Book Review

This discussion about the business of running a medical practice, combined with the author’s personal philosophy of service excellence in patient care, could easily be titled “Business 101 & My Practice Model.”

The author—Michael Harris, MD—is a colorectal surgeon at Mt. Sinai School of Medicine and physician manager of a “45-surgeon faculty practice.” The book is divided into three sections: The “Sharp” Edge—Language and Tools to Excel; The “Smooth” Edge—The Power of Targeted Marketing and Strategic Planning; and What Excellence with an Edge Looks Like.

The main themes are understanding the business side of running a medical practice; taking care of patients, referring physicians, and the office staff; being technically competent to get good results; and recognizing that modern medicine is a competitive service industry with sophisticated consumers.

Discussions of trends in modern medicine—such as consolidation into solo/single specialty groups versus multispecialty/academic/hospital groups; the advantages larger groups have with regard to purchasing power, administration, and marketing; hospital alignments; accountable care organizations; and electronic health records—are covered early. As a specialist himself, Dr. Harris is familiar with the economic problems faced by orthopaedic surgeons (lower reimbursements, higher expenses) but insists on maintaining a passion about his calling and being a leader, not a victim. His goal of expanding his practice’s “sphere of influence” permeates the book.

The sharp edge
In the first section (the sharp edge), Dr. Harris discusses how to manage accounts receivable, presents financial concepts that affect success, and provides a sample business plan for assessing the financial viability of practice investments—from new hires to equipment purchases. These are the “numbers you must and should know,” and he provides the tools for number crunching.

The major theme of this section is that physicians need a “realistic and up-to-date financial picture” of their practices so that they can control the practice instead of vice-versa. Dr. Harris provides numerous definitions, sample charts, and examples to support his thesis. Each chapter ends with a bulleted summation of key points.

I personally found this “Economics 101” review enlightening, understandable, and easy to apply (and wish I’d been taught this earlier in my career). Accounts receivables, fixed versus variable costs, and analyses of costs, volumes, and profits may seem foreign to many surgeons, but Dr. Harris warns readers that ignoring them is perilous.

The smooth edge
The next section examines how to build a practice, how marketing is not the same as advertising, and how to destroy a practice in four easy steps. The author acknowledges the trends of increased government intrusion and marketplace competition. He believes that the best way to promote and position a practice against competition is by providing superior service to patients.

Although keeping an open mind and being flexible are important, exceeding the expectations of both patients and referring physicians through communications and personal contacts is the main message. Dr. Harris suggests ways to involve office staff to promote this philosophy, which benefits both patients and the viability of the practice.

In addition to practice management pearls, Dr. Harris provides examples of personal experiences that illustrate how NOT to run a medical practice (or how to run it out of business). Finally, he provides suggestions on how to cultivate loyalty among patients, referring doctors, and office staff, emphasizing the need for physicians to be “hands-on” with both practice finances and personal daily interactions with all the people who make up a practice and its “sphere of influence.”

What it looks like
The final section shows a hypothetical patient’s journey—from the initial referral from a primary care physician to the specialist’s office visit, surgery, and the postoperative period. Three perspectives are provided (the referring doctor’s, the patient’s, and the office staff’s). Although this section is meant to ground Dr. Harris’s principles in real life, I found it the least helpful portion of the book.

Although Dr. Harris reiterates the classic “Three As” (affable, able, available), he never strays very far from his major emphasis on caring for patients, staff, and referring physicians like they are family. He also provides references for further reading. Personally, I found the first section—on the basics of practice finance—to be the most pertinent, but I think this book is an overall good read and resource.

Douglas R. Turgeon, MD, is a member of the AAOS Practice Management Committee. He can be reached at drt@dallasorthosports.com