This issue contains two very useful articles that may not seem to have anything to do with each other but in fact make an instructive pair.

The first article, “Five Strategies for a More Vital Practice,” by Betsy Nicoletti, concerns itself with strategy, as the title suggests. By contrast, the second, “Three Steps to an Effective Practice Budget,” by Keith Borglum, has to do almost exclusively with tactics. One looks at practice from 30,000 feet, while the other uses a magnifying glass at ground level.

Both views are important. And I would bet that many family physicians spend far too little time looking at their practices from either perspective. If you’re like me, the problem is that the pressures of day-to-day concerns act like blinders, confining you to a dim sort of middle view of things. I can’t imagine how you could find enough time for either strategic thinking or careful analysis of how your practice is working. But that doesn’t make them any less important.

Look at it this way: Are you happy with your practice? If you don’t like the status quo, consider that these articles offer practical ways to improve it.

Following your convictions

Nicoletti’s article may be a little harder to get into than Borglum’s. Part of the reason is that it is necessarily more abstract, given its subject matter. But a larger part of the reason is that several of the “strategies” Nicoletti discusses might better be called convictions or habits. (It’s not surprising if the title reminds you of Stephen Covey’s The Seven Habits of Highly Effective People¹; the echo may well be deliberate on the author’s part.) As Nicoletti suggests at several points in the article, these strategies are not ideas to talk about so much as a way of life. Giving them lip service will gain you nothing. You have to believe in them enough to live them.

I suspect that you already believe in these ideas, or most of them, at least. The problem is that, while you can’t live what you don’t believe, it’s far too easy to live in a way that is somehow disconnected from your beliefs. It is one thing to believe that the patient should come first and another thing entirely to embody that belief in the midst of a discussion of declining practice revenue. It may be that you need to change your habits to suit your beliefs – and you’ve spent far too much time trying to help patients change their health-related behaviors to underestimate the difficulty involved.

Tracking your expenses

While Borglum’s article on developing a practice budget is more down to earth, so to speak, and while it provides step-by-step directions for a definable task, it presents its own barriers to acceptance. Budgeting, you may think, is for the administrator or the office manager. And anyway, who has time for it? Borglum’s answer is that you, the physician, had better make time for it: “It is [practices without budgets] that practice-management consultants such as myself often get called into when finances go awry, overhead seems too high and there is not enough money left for the physicians at the end of the month.”

Actually, here is one point where the two articles connect. One strategy Nicoletti urges is to “maintain focus and discipline.” And the practice budget is one important tool of discipline. Both authors have in mind an image of the healthy, well-run practice, and while it might be dangerous to generalize from what the two articles say, I would not be surprised to learn that the authors share roughly the same vision. Note that both are practice management consultants writing from their experience with scores of medical practices. They offer perspectives no practicing physician could. Each has seen enough practices to say with some authority what makes a good one. As a result, their two articles should be reliable sign posts along two very different roads to the same goal: a better future for you and your practice.