Articles: Quality or Size – Practice Growth At Any Cost?

First of all, these two terms are not necessarily mutually exclusive.

I have seen ample evidence that a practice can be large, very large in fact, and still produce a high quality clinical/technical result.

For this essay, the definition of the word "Quality" does not refer to the quality of the clinical product but rather to the quality of life within the practice for the doctor, for the staff, and for the patients.

The question is, "How does the philosophy, 'growth at any cost', impact the practice and the quality of life within the practice?"

First of all, no doctors I know or have ever heard of will actually admit to the philosophy of "growth at any cost." The decisions made and actions taken though tell the tale.

During the past few months I have had significant, sometimes heated, conversations with doctors, including a number of our clients, who had chosen to abandon reasonable (from my point of view) financial and marketing policies in an effort to attract ever greater numbers of new patient exams and to generate ever greater numbers of case starts.

Some doctors signed up with MSO’s, not as an exit strategy or for any of the reasonable reasons for participating with MSO’s, but simply because they were promised growth.

Others signed up with the various forms of Managed Care (PPO’s, DMO’s, etc.).

Others took out Yellow Page advertisements, did direct mail flyers.

One even put up a freeway billboard!

These doctors would not look at the fact that their new marketing was attracting heavy numbers of extremely low quality patients.

They would not look at the fact that their policy of starting these weak patients with token down payments and long-term financial arrangements would often render the patients uncontrollable.

They did not recognize the significance of the fact that although they only have 10 employees, they had 18 W-2’s to complete at year-end.

One doctor, who had successfully been weaned from participating with five PPO’s, panicked when he realized that his total new patient flow and total case starts this year were less than in the previous year.

He did not consider that in spite of 15% fewer starts he was collecting 22% more revenue, that his rate of failed appointments, emergencies, and incidents of poor clinical cooperation were all much improved.

He did not consider that his clinical and administrative staff was much happier. He cared about one thing and one thing only, how "big" his practice was.

At the San Diego AAO meeting, Dr. Schroeder was lecturing and he made a comment that many orthodontists would consider heretical. He said (and I hope he will excuse my paraphrase of his actual statement) that it is not only acceptable but is desirable to restrict new patient flow and to restrict the rate of case acceptance in order to ensure that the practice only examines and starts the quality of patient that the practice wants to see.

He said that his quality of life within the practice was more important to him than going after every last possible case start.

Interestingly though, that commitment to quality patients and quality starts often generates growth and practice size beyond that which most doctors could otherwise attain.

The foundation or core of our entire credit management system is based on the assumption that the practice commitment to quality of life will take precedence over "growth at any cost."

I have been consulting for more than 19 years and have personally been in more than 750 client offices. We have clients at $33,000 per month and clients at $250,000 per month.

One thing that I have learned and learned well is that the doctors who are able to sustain their practices year after year, with the same staff, with a great net income, with happy patients, with an ever increasing number of new patients referred by existing patients, have been those who were committed to growth but not at the expense of the practice quality of life.

Every decision made concerning the practice, every marketing decision, every staffing decision, every policy decision, should be considered in the light of that decision’s detriment or complement to the quality of life within the practice.

About the Author:

Paul Zuelke is president of Zuelke and Associates, Inc., a leading health care credit management and practice growth company.

The Zuelke corporate purpose is: "To make a fundamental change in the nature of the health care profession by teaching that through risk identification, risk management, and accounts receivable control, our clients will have not only optimum growth, cash flow and profitability, but most importantly, an impeccable quality of life!"

Zuelke and Associates, Inc., can be contacted at: (800) 845-4766

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