In the 1st and 2nd editions of Secrets of the Best-Run Practices, the final chapter was “The Practice of the Future.” After much deliberation, we decided to eliminate this chapter in our 3rd edition published a few months ago. This was partly because we touched on some of the most important trends elsewhere in the book – especially those related to technology, but also the possibility of exploring new service lines to make a career change or reinvigorate revenues. But there was another realization that held us back: the unpredictability of the medical market, which we realize is translating to difficult decision-making for many physicians. (A lot could happen by the time the publisher got the book into the market. So it seemed to make sense to focus on the “Secrets” that would apply no matter what.)

Still, that doesn’t mean we think physicians should be in an indefinite holding pattern with respect to their businesses. Definitely not! Here are some of our observations on grappling with the future and uncertainty.


We find some physicians are discouraged by political implications and big government in general. They feel they have no power over the way they practice and how much they are paid.  This results in frustration that can lead to acceptance of their current situation and sometimes actually believing the future of their practice is not in their own hands. Physicians must remember that not deciding is in fact a decision to maintain the status quo and not take important steps that can improve practice results and their own attitude.

Of all the negative effects of our uncertain environment, this one troubles us the most. Too many physicians are missing out on opportunities to improve their practices today, simply because they are distressed about uncertainty about tomorrow. All businesses deal with uncertainty – and most face much more than we do in medicine. Don’t miss out on important opportunities to run your business more efficiently or enhance patient service because you’ve voluntarily committed yourself to a holding pattern.

Failure to use data

This sense of paralysis about the state of politics and government can also lead to apathy about the data that is available, and how it can be gathered and analyzed. Failure to analyze the marketplace and understand your practice’s own positions (including shifts in key practice indicators from year-to-year) deprives you of information needed to feel in-control and confident about decision-making.

It’s critical to keep in mind that even though we face uncertainty on the political front, we’ve got more data than ever available to us to analyze practice performance! Too few of the practices we work with are taking advantage of all of the insights their own practice management systems and EHRs can unlock. And there’s also more survey data for benchmarking available now than ever – some of it even for free – to help you know where you stand versus competitors as well.

Following the crowd

Physicians see some of their peers making decisions and assume these physicians are making rational decisions, and that they know what they are doing and that their practices will be better positioned in the future because of this. It’s important for physicians to understand, just because colleagues from another practice of the same specialty decide to go on a certain path – whether partnering with a hospital, contracting with a different IPA or adding a non-traditional ancillary service – doesn’t mean it was a good or profitable decision for them, or that it was a smart strategy. And the fact that they did so, without a lot of other information, certainly doesn’t mean it would be wise for you follow their lead. Do your own research and due diligence to make smart strategic choices for you and your partners.

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