Financially Successful Physicians

David Zahaluk, MD, for HealthLeaders Media , June 12, 2008

Did you ever wonder why two similar clinicians can have such similar practices with wildly different financial situations? I see this all the time—similar services, payor mix, age, location, and patient demographics, yet astonishingly different revenues. One is struggling and the other is breaking records every week.

Why? I have researched this field extensively to find a satisfying answer. I studied the business management gurus, including T. Harv Eker, Robert Kiyosaki, Tony Robbins, Dan Kennedy, Jay Abraham, Brian Tracy, Michael Gerber, Suze Orman, Sir John Templeton and many others. The difference lies primarily in the mindset of the two physicians. They prioritize their activities differently and perceive things according to differing values and beliefs.

Successful physicians do the following:

1. Focus on the future. Successful people in all areas of endeavor tend to focus on an idealized version of the future. They think about what things would be like if they were perfect and then they focus their energies on bridging the gap from where they are now to where they want to be. Successful people don't get caught up focusing on the problems, challenges, worries, and frustrations of today.

Successful physicians and physician leaders constantly ask themselves, "How would my practice (or organization) look, feel, interact, and function if it were perfect in five years?" Five years is an important part of the phraseology of the question. According to Peter Drucker, we vastly overestimate what we can accomplish in one year and vastly underestimate what we can accomplish in five years. Choosing a long-term time horizon keeps successful doctors focused on strategically sound initiatives.

2. Keep score. Many professionals, including doctors, are renowned for impulsively putting high ticket items on their credit cards, presumably as a way to distract from the stresses of their career. Expenditures—both business and personal—must be considered carefully. Will the expenditure bring in more revenue? If so, how much and when?

If you're going to buy a whiz bang piece of diagnostic equipment, can you rent it first to make sure it performs prior to committing to the purchase? Can the rep bring it into your office for at least a complete billing cycle so you can be sure the reimbursement is there or to get the patients' perception of the new doo-dad?

Business expert Michael Gerber says that every decision you make has financial consequences. The traditional way to keep score is to sit down with your accountant at regular monthly intervals and evaluate trends in income and expenses. Perhaps an equally important way is to track your net worth (assets less liabilities).

3. Plan better, including for contingencies. Rich doctors tend to have their day's work planned the night before, organized into lists for better follow through.

Better planning doesn't just involve attention to detail, though. It also includes a keen recognition of what does not need to be done on your list. According to T. Harv Eker, "cleanups, completes, and deletes" are important to you psychologically. Anything that you committed to but didn't follow through on or are procrastinating about carries a heavy mental weight in your psyche. Eker encourages you to every week either delegate a task, resolve to complete it once and for all, or acknowledge that it is no longer important to you and allow yourself to let it go.

4. Work to the clock. Marketer extraordinaire Dan Kennedy writes ad campaigns for $100,000 per project and up. He acknowledges that the best thing in the world for him is a deadline.

Working to task and to the clock, keeps him crisp, focused, and efficient. The structure of deadlines and commitments improves performance in the same way a speed skaters performance improves when her coach is measuring her performance with a stop watch.

5. Build championship teams. You can't become extremely successful at anything alone. You not only need the help of others, but you need the help of the very best people you can find.

This means that you have to have all the team members talking together and you have to sell them on your plan, your vision. I often hear from clients that their staff just doesn't want to work, doesn't want to be told what to do, and basically hasn't bought in to the vision of the practice.

I'm really a "nice guy" at heart so this is a little hard for me to say. Sometimes there is nothing better for the success of a practice than a few well-earned pink slips. Usually the rest of your staff knows when someone needs to be fired long before you do. The good ones are always relieved when the troublesome employees are fired. It is a reminder to everyone of the reason they are there in the first place. Building a championship team means you sell your vision to the team members so they can carry you forward to your ultimate destination.

6. Have high self esteem. Every one of us functions at peak levels when we align our values with our actions. In our consulting group, we insist that every client goes through a values clarification exercise at least quarterly. When your actions contradict your innermost values and beliefs, you experience stress, worry, frustration, and even anger and resentment. It has been said that every human problem can be solved by a return to values. Yet so few organizations approach workplace problems this way.

Your past achievements provide insights into your values. What have you done in the past that made you feel intense personal pride? What are the activities that you were involved in that made you feel the happiest? What activities have you participated in that you would do even if you didn't get paid for your involvement? Somehow, those activities allowed you to experience a value that you hold dearly.

Self esteem happens when we act on our values. High self esteem is absolutely necessary for success. According to Steven Covey, "While you're scrambling up the ladder of success, make sure it's not leaning against the wrong building."

7. Take action. Rather than getting stuck in the paralysis of analysis, successful doctors live in the field of action. They tend to bulldoze through multiple projects simultaneously. They tend to make decisions before all the facts are in. In a study or Fortune 500 CEOs, the typical CEO makes a decision when 30%-70% of the relevant information is in. They shoot from the hip.

At the same time, successful doctors tend to look closely for feedback on what is working and what isn't in their endeavors. They use this feedback to make an adjustment in their method and quickly move back into a new action. They continue to alter their methods until they finally get what they want. They are decidedly biased in favor of action.

8. Model what works for others. You won't find a highly successful doctor doing his/her own taxes. However he may call 20 of the most successful people in his/her circle of influence to get the name of a great accountant.

Rather than reinvent the wheel, these success-minded people tend to keenly observe what works around them and try to implement it into their lives by "modeling successful behaviors."

9. Respect and learn from more successful people. Rich people tend to not get immobilized feeling envious of others. They tend to seek them out and learn from them. Business guru Jay Abraham advocates taking a millionaire out to lunch once a month. Successful people are often surprisingly generous when it comes to sharing their wisdom and contacts with someone who has a genuine desire to improve their situation. Better yet is to form a mastermind group that meets monthly to allow the flow and interchange of best practices and ideas from a number of highly successful people. The clients in our mastermind groups learn the fastest because they process the new material at such a high level.

10. Invest in education. If you think education is expensive, try ignorance. Financially successful doctors are constantly learning, growing, and challenging themselves to be better people—not just at making money, but at everything. High education and intelligence correlate with high self esteem. Why not take advantage of that fact and commit to education in all facets where it is important to you.

Can a physician really feel great about him or herself if they are out of date with their clinical acumen? Or for that matter if they are out of shape physically? Or if they can't pay their bills because their practice isn't profitable.

The best reason to educate yourself is the growing confidence you will gain that you have what it takes to manage anything life throws at you. I think that is what it means to be rich—confidence and certainty that you will be okay no matter what.

David Zahaluk, MD, is a practicing physician, author of The Ultimate Practice Building Book, and the founder of "MIP Consulting Group," a coaching and consulting group for physicians only offering innovative solutions to practice marketing and staff development. For more information, visit

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