When Goals Become Responsibilities
Dr. A had just turned forty years old. He operated a successful private practice grossing about $500,000 a year. His income after expenses was about 48% of the gross collections, which enabled him and his family to enjoy a good living. His staff was well trained, and staff turnover problems seemed to have been eliminated. He practiced four and a half days a week. His practice was stable and maintained a steady flow of new patients. He no longer felt compelled to work any evening or Saturday hours.
He was married and had two children in school. He played tennis two days a week and enjoyed reasonably good health. He had a nice house with a mortgage, and he drove a nice car back and forth to the office. He and his family took two weeks vacation every year (usually where they were holding a continuing education course so the vacation could be written off for tax purposes). He had a college fund set aside for the children and had recently begun putting money away into his own retirement program. In short, he had achieved what everyone considers to be the American dream.
The problem was…he was not really happy!
You see, doctors are natural born achievers, very goal-oriented people. Goal-oriented people have a tendency to avoid responsibility while in pursuit of goals. Reaching goals is the objective. Having goals means that you are free while in pursuit of that goal; the only responsibilities or burdens you carry are those directly related to that particular goal. Responsibilities, on the other hand, hold you back and can even prevent you from accomplishing goals.
Goals are exciting; they are accomplishments, something to be pursued. Responsibilities, on the other hand, are a burden, something to be avoided. How can you possibly accomplish goals if you are burdened with responsibilities?
Goals begin to be set as early as high school years: getting good grades in order to get admitted to the right college. In college, the environment becomes competitive as students set goals such as qualifying academically for admittance into a doctorate program. Once admitted, the goal is to out-do and out-perform the others and to graduate as the best clinician in one’s class. These goals were more immediate, short-term, and were replaced by new goals each year.
Upon graduation, the next goal is to have that successful practice we just described. There are the goals of building an office, drawing plans, supervising the construction, selecting equipment, etc. Everything is exciting. Each new goal is achieved quickly, and then on to the next one. Staff is hired, and one learns how to operate a practice.
The goals for the first ten or twelve years after graduation seem endless. Building and organizing the practice, paying off bank loans, buying a house and new car, getting married, having children, meeting new friends and discovering new places to see. Everything is incredibly new, and those years are filled with so much activity that one seldom has time to think about where he is or where he is going.
Somewhere between the age of thirty-six and forty, something happens to the goal-oriented doctor. As each goal is accomplished, new goals don’t crop up to replace those already met. After five to ten years into practice, the goal of building the practice is usually accomplished, and now it is a matter of having the responsibility to maintain it for the next thirty to thirty-five years. The goal of building the family’s dream house now becomes a responsibility to pay off and maintain during the next thirty years.
Then there is the family. The birth of each child is an exciting event, but soon the children, while a joy to experience, become a demanding responsibility in both time and money. One is not free to travel as before, and besides, it is too expensive to take the children along on exotic vacations. The fun-loving girl he married is now a mother, and with that change comes the responsibilities of raising a family. While the family provides much joy and happiness, it also represents a great deal of responsibility for the next twenty to twenty-five years. The American dream is now accomplished, but now the entire dream has become a responsibility.
Goals do become responsibilities!
Buying new cars or a vacation home adds excitement, but is a short-term fix. Hunting and fishing trips and out of town meetings provide a means to get away from the office in order to forget the responsibilities.
One doesn’t understand what is causing these feelings. It’s a mystery to the individual and his family. Friends say it’s a mid- life crisis. One becomes aware of his own mortality. He looks back twenty years ago when he was twenty, and ahead twenty years when he will be sixty! Yes, age is a consideration, but it must be accepted as a part of life.
The Catch 22 Syndrome:
The biggest eye opener for the goal-oriented doctor is the realization that as goals are achieved, more responsibilities are incurred. The doctor feels that he has a heavier burden to carry than most people do, which is true. One of the reasons for this, however, is that, as a goal-oriented person, the doctor spends much of his life in pursuit of those goals, which then become responsibilities!!!
Is there a way out of this dilemma? The answer is absolutely maybe! We will address the possibilities later.
At this point, doctors may begin to display one or more of the following “clinician syndromes”:
- The Mammoth Office Syndrome – Makes plans to construct a huge, new office building. This project is a new goal, short- term though it may be. The bigger the building project, the longer it takes, and the more expensive it is, the more exciting it becomes. After it’s completed and the doctor moves in, he may soon realize he has only strapped himself with more responsibility. He may not realize he has increased his fixed overhead without necessarily increasing his
- The Mammoth Practice Syndrome – Attends practice management seminars where he is told that happiness is a $1,000,000 practice. He learns how to shave seconds from each procedure and adds more staff (more fixed overhead expense). Once he has built this monster, he can no longer enjoy vacations because the additional fixed overhead expenses eat away profits in his absence. He has strapped himself with more
- The Ambiguous Associateship Syndrome – Hires an associate, offers no contract or a one-sided agreement, makes no commitment to the associate and gets none in return. Keeps the patients to himself. The associate leaves at the first offer of a better opportunity, so he hires another— and another— until he decides associateships don’t work (do it the wrong way, have it fail, and decide the right way must not work either!). Makes himself responsible for all the future clinical work needed for the practice. More responsibility!
- Specialty Syndrome – Sells his practice and goes back to school to specialize. This sets him back many years financially and can add a great deal of stress to his life. Then he must start over in a limited specialty, providing services that many financially strapped general practitioners are providing themselves. It’s a whole new struggle, a new goal, and although it’s a lot tougher than most, it is not humdrum. That is, until it’s built, and then it too becomes another
How can you avoid all this? Set personal goals and make plans for your practice to provide the means for achieving those personal goals. Your practice should not dominate your life, but it should provide for YOU, as well as for your family.
What should those goals be? Well, for one, you should have goals that enhance your quality of life. For example, one goal should be to practice on whom you want, provide the services that you want to provide, when you want to provide them.
Secondly, having freedom from the overhead monster that your practice represents should be a quality of life objective. This can be accomplished by having partners or associates practicing with you to partially eliminate the negative cash flow caused by your absence. You must give them a fair deal and a secure future, and for everyone’s protection, the arrangement ought to be secured by more than “a verbal agreement and a handshake.” The needs of both parties should be addressed contractually to make the arrangement mutually beneficial. Additionally, apply business concepts to your practice that will provide operating profits so you are not dependent upon your clinical production as your sole means of income. Get out of the “Solo Economic Dependency” trap.
Lighten the load. Lessen the stress, but don’t expect to eliminate it. Don’t have unrealistic expectations, but do have a plan. If you have a plan, you can accomplish your goals. You need goals that are realistic and do not add more responsibilities. It won’t happen by itself. You will have to make it happen. There are many business principles that you can apply that can maximize the economic benefits of practicing while decreasing, not increasing, clinical involvement. Some examples are practice mergers, partnerships, associateships, or selling one’s practice and working as an independent contractor for the purchaser. You will have to think and act more like a businessman, and if you do, your life will be far more rewarding than one dominated by the “Clinician Syndrome” disasters.
We welcome your response, and look forward to providing assistance in planning your future.