Leadership is always difficult when massive change occurs in any particular industry. Healthcare is no different. The current environment is wrought with change and especially difficult for independent physicians to navigate.
After being saddled by healthcare reform, many surgeons in independent or small practices found themselves in economic trouble as their colleagues and referral sources became hospital employees and new regulations forced expensive changes at their practices. In some markets, employment seems like the only option; in others, simple alignment is possible. There are still many spine surgeons in independent practice today, and many more coming out of fellowships or off initial hospital employment practices wondering whether independence is right for them.
The first question to ask is: Do you want what private practice surgeons have, or do you want to do what private practice surgeons do?
"People are motivated by different things, and you have to really and truly understand what you want," says Richard Kube, MD, founder of Prairie Spine & Pain Institute in Peoria, Ill. "A lot of people want to be the head of a company, making all of the decisions, and having a nice income, but many of those people all just want what I have. Most of those same individuals would not sign up for my hours, personal financial risk and management of staff. You need to really understand what it takes to get there because control (or at least the illusion of control) does not come without sacrifice."
Here are the most important tips for leadership during times of change:
1. Don't ask someone to do something you're not willing to do yourself.
2. Go the extra mile for your practice; be the first to show up and last one to leave.
3. Leading can be a thankless job; be sure to provide praise to those helping you to reach goals.
4. Put the time and effort into achieving your goals; don't cut corners or get distracted.
5. Don't be worried about the negative things happening around you. There will always be some form of adversity, so learn to manipulate those things into positives.
6. Plan on unplanned events and be able to evolve rapidly.
7. Don't spend too much time worried about the competition. Instead, focus on what you've accomplished and where you're going.
8. Realize you won't be successful at everything you do.
"There are a lot of things that don't turn out the way you expected or wanted, whether it's a new regulation that shows up or a key member of your staff leaves for another opportunity that allows them to grow even faster," says Dr. Kube. "You can't be distracted by those things. You have to anticipate surprises and evolve quickly to maintain growth. Don't become a victim of your own inertia; you can make the right decision, the wrong decision or no decision. Two of those three options are wrong; keep moving forward."
The next challenge is making the right decisions. Few people have the entrepreneurial spirit allowing them to really get things done; even fewer people have the foresight to make the right decisions along the way.
"It helps for you to understand what's going on in the marketplace and look ahead to new legislation, and regulation. Do not allocate excess time studying what you're competition is doing. Use their actions only to help you understand the local market forces. Let your competition otherwise take care of itself," says Dr. Kube. "They can implode with poor decisions. Exert as much energy as possible in improving your product, understanding your customers and what you are trying to deliver. That should be your key focus. If you are your own main competition, your imagination is your only limit."
Beyond the practice, physician leaders are also becoming more involved in the political process. This is especially true for private practice physicians, who have their livelihood threatened by new regulations favoring large institutions and physician employment.
"In general, physicians need to become more involved in the political process," says Dr. Kube. "If we don't become involved, we will allow the bureaucrats write the legislation for us. When I talk to politicians at the state and federal level, there is a general sense that politicians believe physicians are apathetic, and I think that's a bad thing. The landscape is always going to change, and we need to be cognizant about how our decisions impact the national debt and access to healthcare in the future. Politicians are worried about those things so we should be too."
Independent physicians are also becoming more aware of economic policies as small business owners and advocating for their ability to stay in business.
"You need to stay informed and not be afraid to read or watch the news," says Dr. Kube. "Don't be afraid to support politicians if they share your beliefs. You are a constituent who is generating jobs, and your opinion should be heard. Speaking up is how you gain access to the political system. Physicians have an important job, but politicians aren't going to listen to you just because you're a physician. You have to engage instead of just showing up when you want something. The reality is, if you're not involved in the political process, your voice won't be heard."