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About Philippa Kennealy

 

Philippa Kennealy MD MPH CPCC PCC is The Entrepreneurial MD Business Coach who wants to help you build your business!
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Thursday
Feb152007

Raising your Resilience - A Success Secret for Physician Entrepreneurs

02-15-07thinking.jpgThis is a philosophical blog post coming on the heels of a meeting I had today with my "Mastermind group". We talked at length about the topic of resiliency. It appears that many physicians are feeling less than hardy these days in the face of all their practice struggles! They are worn down by the endless "rules" and the relentless pressure to see more patients while taking home less money.

I also thought back on the many conversations with I've had with successful physician entrepreneurs and how they have resounded with one near-universal insight - almost everyone has remarked on how critical the traits of persistence and resilience have been to their success.

Seems kind of self-evident, doesn't it? But it's a lot easier to think and talk about resilience than it is to figure out how to develop it.

Several years ago, I was struck by a book I read that was authored by Dr. Martin Seligman, an esteemed psychologist and the so-called "Father of Positive Psychology". I was a fairly new and earnest parent at the time, and was drawn to his title of "The Optimistic Child".

Dr. Seligman's premise was that you can "immunize" child against depression by teaching them to observe, check for accuracy and then dispute many of the "automatic thoughts" that pop into their heads. His research proved him correct and he and a colleague developed the highly successful Penn Prevention Program for school kids.

Demonstrating to children that thoughts were both verifiable and changeable, and teaching them social problem-solving skills were at the core of his program. Children were taught how to catch their fleeting, automatic, self-critical thoughts, judge the accuracy of their pessimistic thoughts and self-accusations, and also handle interpersonal conflicts.

So what does this all mean for us as adults?

How many times a day do you put yourself down, believe yourself to be unworthy in some way, or distort a situation by imagining the worst outcome? My bet is that you're pretty hard on yourself. Without realizing it, you probably use your thoughts to hit yourself over the head repeatedly with a large hammer.

One of the best antidotes to pessimistic or judgmental thoughts is a dose of The Work - a tool I use on a regular basis with my clients to help them investigate their stressful thoughts.

The creator of the tool, Byron Katie (known familiarly as Katie), has a great tagline on her website that describes the potential impact of her tool: "I don't let go of stressful thoughts. I question them. Then they let go of me."  I love picturing a life in which my lousy thoughts just let go of me!

In fact, this tool is a very practical method for investigating your own thoughts and "fact-checking" for reality, versus what you have made up in your head. 

My slightly modified version of The Work is a six-step process that begins with you identifying the thought that is causing you to feel bad or stuck. You may have to even check in with your body - your breathing, your "abdominal sensations", your neck and jaw muscles, to figure out what that thought is. As a novice in this process, you will find it helpful to write the negative thought down.

And then do the following:

Step One: Ask yourself "Does this thought seem true to me?" Answer Yes or No. If your answer is "No", there is no need to go any further.

Step Two: Ask yourself "Can I be absolutely sure that this is true?" Again answer Yes or No.
If you answer "yes, I'm absolutely sure", you are confronting reality. You have to deal with that.

Step Three: Ask yourself "How do I react when I think and believe that thought? Specifically, how does this thought make me FEEL and how does it make me ACT?" 

Step Four: Ask yourself "Who would I be if I were no longer permitted to have this thought? What would my life be like?" Picture yourself living without this thought - how would you feel? What would you do, or not do, differently?

Step Five: Now turn your negative thought around 180 degrees. Try not to go to the extreme unlikely opposite but to find a thought that feels at least modestly comfortable!
So go from "I won't be able to start the business I want to, becasue I never have any spare time" to "If I pay attention to how I use my time, I likely to be able to find small blocks of time several times a week to work on my idea" (instead of the much less realistic "I'll be able to start a business because I really have plenty of time"!)

Step Six: Finally ask yourself "If I put that second thought up against the original thought, is the second thought at least as true as the original thought (if not more true than it)?"
In essence, you are comparing one "fiction" (the thought you proved in Step 2 was NOT true) with a second "fiction" (a new thought that you haven't yet proved true). You are seeing whether the second thought is a least as viable as the first. Now, if the second thought feels at least as true, choose to feel and act as if it WERE true, and see how that works for you.

Once you get this down pat, you will be surprised by how much more resilient your thinking becomes. Because most of what plagues us is self-created!

What helps you endure? Do you have any other suggestions to help your colleagues become more resilient? If so, please share here.

Tuesday
Feb132007

Finding the time to start a business, when time is in short supply

2-13-07stressedout.jpgIn response to my question of "What is your biggest question about starting a business?", a physician whom I shall call Dr. C. emailed the following to me yesterday: "How to manage time of what would seem to be a time-consuming commitment while still in a busy medical practice?"

Well, that certainly is a legitimate and difficult question, and since I suspect it reflects one of the concerns many of you share, I decided to answer Dr. C's question in a blog post.

At the heart of my answer is the idea of passionate commitment. You have to really want to do this!

You have to long to either create an exit strategy from the current life that is no longer satisfying you, or to heed the siren call to express your creativity and experience the stimulation of building a business.

For any busy doctor to contemplate starting a business or revamp a medical practice to be more entrepreneurial, you will need to carve out three kinds of time - Thinking time, Planning time and Doing time.

Thinking time - this is the time devoted to brainstorming, mindmapping, schmoozing with colleagues and friends to test out vague ideas, doodling, doing Internet or offline research, and daydreaming. You are setting out to answer the question of "What?"

Planning time - this time is spent mapping out business and product/service production processes, setting up systems, figuring out what to delegate, filling in spreadsheets, consulting a CPA or business attorney, designing and producing prototypes, pricing products or services, writing business plans, creating marketing plans, and having someone design logos and websites. This time you are answering "How?" 

Doing time - no need to explain this one! During this time, you might be filing forms for your business name, approving a website design, purchasing supplies, organizing and setting up workspace, hiring staff, setting up your accounting systems, operationalizing your business and marketing plans, and actually delivering the goods.

In most cases, you must do the thinking and most of the planning yourself. During this time, you are not only crafting your idea for a business, but also articulating what the vision and purpose are for your business - what will this business mean to you personally, and what must this business stand for in the world?

The "Doing time" is where you have the most flexibility. Much of the doing can be delegated and outsourced, especially if you make that part of your planning.

So, assuming you are fired up with passionate commitment, how do you find the time? Here are my Top Ten Tips for you:

1. Draw strong boundaries: Time is a fixed resource - we all receive the gift of exactly the same 86,400 seconds per day. You will need to get your values and priorities very clear, so that you can begin to protect "untouchable" blocks of time with well-drawn boundaries. I truly believe the most useful word in the English language is "no". It is also one of the least well utilized with the exception of two year olds! The secret to protecting time is to decide what to say no to - otherwise, by saying yes to everyone else, you are saying no to your dreams. In order to create high-quality Thinking time, you will need to have steel-reinforced fences around the perimeter of your time to avoid distractions.

2. Cut back your work hours: If you were to stop seeing patients 60 or 90 minutes earlier or start later once or twice a week, how much time could you free up? This will only work if you are willing to protect the freed up time.

3. Schedule "appointments" with yourself: I suspect you wouldn't surf the Internet or answer email in the middle of a patient's appointment. So how would it be to schedule appointments with yourself (perhaps in those freed-up times from Number 2) that you handle like patient appointments? No interruptions except for emergencies, no idle procrastination, no socializing unless it has a specific purpose related to the development of your business idea.

4. Cut back your recreational hours: If you were to scan your life a week at a time, where could you cut back on your play time, and dedicate it instead to fulfilling your dream for an entrepreneurial venture? This may seem like too much of a sacrifice to contemplate, and it may not work for you, but it's been my experience that the creativity of fleshing out business ideas has the same recreational and "fun" value for me as going to a movie or hanging out with friends at a coffee shop!

5. Use vacation time or take a sabbatical: Again heresy you might say! And again I argue, it works IF you feel excited and energized by your business idea. What would the impact be on your ability to move your idea forward if you could set aside one or two vacation days a month and spend most of the day thinking, planning or doing? This is what Dr Dunaway did in order to complete the writing of his first commercial product.

6. Develop a process for tackling the tasks: By this, I mean having a system set up that works for you and permits you to tackle a few tasks every day, or every day that you are not on call. If you have time open up because of a patient no-show, one option is to use that 20 or 30 minutes (or 5!) to do some quick and disciplined Internet research, or set up one networking appointment. You'll be amazed at what you can accomplish if you have an updated list of Planning and Doing tasks.

7. Stop wasting time: Please take a moment to reflect honestly on how much time you waste in a day. If you are sincere in responding "none", I don't have much to offer you other than the sacrifices mentioned above.
It has been estimated that we could pay for the care of the uninsured in the US if we were to eliminate waste from our healthcare system. In the same way, you could in all likelihood build a wildly successful business AND stay in practice just by taking all that wasted time and using it efficiently. Commitment to this goal might mean taking a hard look at how you use your spare time, or an even harder look at how you work.

8. Plan ahead for only the next four or five days: Busy physicians have schedules that change frequently. It may be a challenge to plan your next few weeks. However, most people have a good idea of what their next four or five days will look like. What time might you be able to discover and set aside if you were to look ahead at your schedule every Sunday night or early Monday morning and identify those possible "appointments with yourself"?

9. Don't go it alone: As physicians, we're an independent-minded bunch of people - right? In my conversations with successful physician entrepreneurs, I learned from many of the "trailblazers" that a key ingredient for their success was the early recognition that they needed help. Help with thinking - finding a partner or buddy to brainstorm with; help with planning - involving smart business-savvy professionals early; and help with doing - hiring staff as soon as the workload called for it or outsourcing tasks to others if it made financial sense.

10. Remind yourself of your passionate commitment: No matter how willing you are to try any of the above, you will be unlikely to find the time unless you are dedicated to looking for it. if you have a dog-eared, rumpled and very handy list of excuses to pull out with the slightest mention of time, you are not committed enough!
I ask both my clients and myself, when whining that there isn't enough time, the question: "Who are you really kidding about your dreams of starting a business?" or "What kind of wishing thinking game are you playing?" That is enough to sober up any serious entrepreneur!

If any of my readers have other ideas that might help Dr. C., please write them in the comments area (see the Post a Comment section at the top of this article)!

***************************

And a very Happy Valentine's Day - may you experience all the love, affection and appreciation you need to feel satisfied today! 
Tuesday
Feb062007

Networking Made Natural: Top Tips for Physician Entrepreneurs

1-22-07rolodex.jpg

The Entrepreneurial MD's monthly newsletter article for February is now ready for you to read.

It's titled Networking Made Natural: Top tips for physician entrepreneurs, and I wrote it after being inspired by listening to an interview of the author of "Endless Referrals", Bob Burg, by Robert Middleton of Action Plan Marketing.

As I listened to the interview, what struck me most was that Bob's networking techniques were so non-threatening and yet so disciplined that even an introvert could master them!

As I am a fierce proponent of the relationship-building model of marketing, I plan to devote space in at least one more newsletter to help you discover interesting and manageable ways to develop the all-essential skill of networking! You'll use it to your advantage whether you plan to be an entrepreneur or not.  

If you have any questions you'd like answered, here's the place to post them.

Monday
Feb052007

What does an entrepreneurial medical practice really look like?

2-5-07skinproducts.jpg

On a personal note - having just returned from a vacation in Mexico with my family, I was thrilled to realize that I was really looking forward to getting back to work - I missed writing my blog and talking to my clients! Sick, isn't it?

It also helps that it is warmer in Los Angeles than it was on some of the days in Cabo San Lucas!

********************

As someone devoted to helping physicians thrive as entrepreneurs, often within the context of their existing practices, I am always on the lookout for ways a medical practice can be more entrepreneurial.

An article from the Los Angeles Times, entitled Medical merchants: When doctors hawk products, patients aren't the only ones who pay a price showed up in my Inbox today. It resonated with me because I feel strongly that selling private label over-priced products to patients is the lazy person's path to being entrepreneurial. It smacks at best of a lack of imagination, and at worst of quackery .

I had an identical experience several years ago in a dermatologist's office, when I was pressured by the back office nurse to purchase a $29 tube of "special sunscreen for the face". I had detected the almost imperceptible signal given by the doctor to her nurse to push the product, and yet I still felt too awkward to refuse it, especially as the doctor had written IO ("insurance only") on my superbill. What a trap I had created for myself by accepting that IO! And how resentful I felt after leaving the suite. Similar to the subject in the Times article, I did not return to that office.

Like many physicians, I bet you've wracked your brains trying to think of ways to offset your declining income, with all the insurance cutbacks. However, as the article points out, pushing creams, vitamins and "pick me ups" is more likely to cause your patient to cringe resentfully as she forks over the cash, than to create an undying trust in your recommendations.

In the same way, adding testing like EMG studies and nerve conduction studies, or heel ultrasound to screen for osteoporosis can be justified only IF you are willing to use these technologies when indicated, and not as a slick way to generate extra revenue. What we know, per the Dartmouth Atlas of Healthcare, is that the mere existence of a technology means that it will be used, and almost certainly overused, without any improvement in patient outcomes.

I had to review a primary care physician's medical records last year - about 20 of them - and was dismayed to see that every single patient record contained spirometry studies and a urinalysis, irrespective of the presenting complaint. This is NOT entrepreneurial behavioral - this is a desperate attempt to rip off the insurance system without any benefit to the patients!

So what are some creative ways to be entrepreneurial in a medical practice?

Okay, I know that concierge medicine and medical spas are IN, but I believe that it doesn't take a drastic change in your practice to produce entrepreneurial results. It DOES take a deeper understanding of what your patients would value and therefore be willing to pay for.

Since I take the fierce stance that entrepreneurship is a radical act of creativity, here are some simple examples of what I picture an entrepreneurial medical practice to be selling or engaging in:

  • patient education - such a group classes for diabetics, asthmatic teenagers, and new parents.
  • information/education products - such as "self-catheterization" or "self-injection" technique videos, "how to use a pedometer for a 10,000 steps a day walking program" video and handbook, a "how to look your best after a mastectomy" guide, a "how to prepare your child for surgery" audio CD, or a book on "maintaining your spine and wrist health, for computer users" that you co-author with your favorite chiropracter.
  • using technology to streamline office practice operations - such as web-based appointment systems for patients to schedule their own appointments (nope, you don't have to build it. It is entrepreneurial to purchase it and redesign your practice to derive maximum benefit from it). Or to begin using email more effectively to communicate with your patients
  • additional services and complementary therapies - such as acupuncture (many reputable schools now offer training for physicians), or renting extra or after-hours space to nutritionists, psychotherapists, or the master herbalists your patients are secretly seeing.
  • office-based procedures that you would have referred elsewhere - such as getting extra training in minor skin surgery, lump and bump removal, performing colposcopies and infant circumcision.

What are your thoughts about entrepreneurial medical practices? I'd also love to hear of other examples of entrepreneurial activities everyday practicing physicians are engaging in - do you have any to share?

Friday
Jan262007

If you don't have a business plan, are you really in business?

1-27-07roadmap.jpg

The Wall Street Journal published an article in the Small Business / Enterprise section a couple of weeks ago, and its provocative title was "Do Start-Ups Really Need Formal Business Plans?"

The author, Kelly Spors, highlighted a recent study (which you can read here in detail if you have time on your hands!) that revealed that it's a waste of time to spend months crafting a meticulously worded formal business plan, when you'd really benefit from "just doing it!"

From the article and in the words of some critics of formal planning, "it (a business plan) runs counter to what is at the heart of the entrepreneurial spirit: the ability to learn and adapt through experience." In addition, recent research seems to suggest that extensive formal planning may not make much difference to the success and profitability of a venture. Phew - what a relief for someone like me who doesn't have a typed-up formal BP!

Others counter that "plans give entrepreneurs focus and prevent costly mistakes".

However, whichever camp you sit in, most agree that the sound analysis and good clear thinking that go into business planning cannot be skipped. Having a "roadmap" to consult and to set your direction will prevent problems such as underfunding, overestimating your potential profitability, and failing to understand how your business model will generate your required revenues.

I enjoyed reading Guy Kawasaki's take on the WSJ article, as well as that of Jeff Cornwall of The Entrepreneurial Mind

One bullet in Guy's blog post caught my eye - "Keep it short: ten to twenty pages".

What if your business plan could be reduced to one page?

Jim Horan, author of one of my favorite work books - The One Page Business Plan, believes it's possible. And I am excited to let you know that he has agreed to be my interview guest in The Entrepreneurial MD's complimentary monthly teleclass of April. So keep an eye out for more details closer to the time.

I shall be taking a break from blogging next week as I'll be on vacation - unless I am hit by an irresistible urge to share something good!

Have a great week.