How to respond to "the lure of great wealth"

An astute physician reader wrote to me today and drew my attention to an article in the New York Time Business section today, called "Gilded Paychecks: Very Rich are Leaving the Merely Rich Behind" or "how the lure of great wealth affects career choices".

In the article, the writer describes the journey of a hematologist-oncologist, Dr. Robert Glassman, from his academic aspirations (including winning a Nobel Prize) to having a seat on Wall Street as an investment banker specializing in biotechnology and new drug investments.

In the article author's words:

What Dr. Glassman represents, along with other very rich people interviewed for this article, is the growing number of Americans who acknowledge that they have accumulated, or soon will, more than enough money to live comfortably, even luxuriously, and also enough so that their children, as adults, will then be free to pursue careers “they have a hunger for,” as Dr. Glassman put it, “and not feel a need to do something just to pay the bills.”

I particularly enjoyed the on-the mark observations in a follow-up e-mail from my physician reader:

I thought it (the article) was interesting because: first, it does show that some physicians (and probably more than before) are leaving academia and practice to, for example, work for Wall Street. Nothing new, but it seems like this is a more prevalent situation.

Secondly, medicine for a lot of physicians does guarantee a steady paycheck, most of the time. However the paycheck is nowhere near - in terms of financial security - where it used to be, even 10 -15 years ago, especially for young i.e. just starting physicians and in non-surgical specialities.

Thirdly, it shows that most of physicians can easily transform into other type of work and be successful.

And lastly, most of them still want to practice medicine for the joy of it, not the money.

And of course the gap between well-educated professionals who work hard and overall do OK and those that do not necessarily have any more education or work any harder and still strike it rich, is rapidly widening.

Since we are talking about money, a lot of starting salaries for non-surgical specialities are in the low $100,000's. A starting internist salary at a university I used to work at is $115, 000. With escalating housing costs, it does not even allow one to save enough money for a down-payment in any reasonable time, not too mention comfortable living. I am not saying $100,000 is not a lot of money, because by global standards it still is and American MD's make more than their Europeans counterparts ( although in Europe education is less expensive and the work week is much shorter, so the real gap is less than most of us think - average physicians' salary in the Netherlands is I think $160,000). However, for a lot of physicians - pediatricians, internists, family practitioners, psychiatrists etc. - living with "no financial worries" just because "they are doctors" is no longer true.

I could not have analyzed the article better.

I do confess to having experienced a moment of hypocrisy about whether to highlight this topic or not!

I'd like to believe that there resides in the hearts of all physician entrepreneurs the pure desire to continue to do good in the world. And I'd like to avoid the focus of my efforts with The Entrepreneurial MD being merely about how to make doctors wealthier. That purpose makes me squirm - as if I and my business have somehow lowered myself to some crass, money-grubbing standards (can you see how alive and well my Inner Critic is? <smile>)  

And yet, I too want great wealth, for many reasons. Some are personal and others I'm willing to go public about, such as "embracing philanthropy as an alternative to a life of professional accomplishment".

What are your thoughts about great wealth??

E-mail Etiquette and Security

Thanks to the eclectic collection of articles that Aussie techie Leon Ho of Lifehack.org posts almost daily in his blog, I am able to tap into a wealth of information floating around the Web. Some of it is incredibly helpful!

Like an article he made me aware of today, called 99 Email and Security and Productivity Tips.

The tips range from simple cyber-manners to effective communication and maintaining your privacy and security.

It's the kind of list that you'll want to browse after dinner, when the kids are in bed, and the household is quiet - it's detailed and thorough! And even if you commit to attending to just 3 relevant tips a day, you're bound to be able to manage your email chaos a tad better.

Now if only someone would design and build a special kind of hell for spammers - perhaps one in which they were force-fed, at 6-hourly intervals, the medications they're pushing or obligated under pain of death to listen to endless loops of their own garbage nonsensical wording. Any other ideas??

Is social entrepreneurship for you?

I'm often asked by physicians considering starting a business: "Where or how will I find ideas for a business?", and I'd like to share this blog post with those of you who have that question foremost on your mind.

Consider this as one option available to you!

One of my favorite entrepreneur role models is Dame Anita Roddick, founder of The Body Shop International. She embodies the gritty, idealistic, pragmatic, dogged, opinionated and socially conscious characteristics of a visionary leader and businesswoman, and I love her for these traits!

I was delighted to come across an article published last week in the Financial Times, written by Dame Roddick, with the provocative title of Don't get a business degree, get angry.

She pooh-poohs the idea that entrepreneurship can be taught effectively in business school. Instead, she argues......

....... potential entrepreneurs are outsiders. They are people who imagine things as they might be, not as they are, and have the drive to change the world. Those are qualities that business schools do not teach. An MBA can give you useful skills that can be applied to a life in business. But they will not teach you the most crucial thing: how to be an entrepreneur. They might also sap what entrepreneurial flair you have as they force you into the template called an MBA pass.

.....I am not at all convinced it is a subject you can teach. How do you teach obsession - because often it is obsession that drives an entrepreneur's vision? How do you learn to be an outsider if you are not one already?

In the business school model, entrepreneurs are most at home with a balance sheet, a cash-flow forecast and a business plan. They dream of profit forecasts and the day they can take the company public. These are just part of the toolbox of re-imagining the world: they are not the defining characteristics of entrepreneurship. The problem with business schools is that they are controlled by, and obsessed with, the status quo. They encourage you deeper into the world as it is. They transform you into a better example of corporate man. We need good administration and financial flair, after all, but we need people of imagination too.

Her prescription for becoming an entrepreneur?

Become angry. Feel your outrage. Notice what frustrates you.

• What infuriates you about the way healthcare is delivered? By the health plans? In your hospital? In your own practice?
  
  
• What is so broken it makes you want to scream?
  
  
• What would be worth your time and passion to fix?
  
  
• What really sucks for you as a doctor? For your family? For your patients?
  
  
• Whose lives could be dramatically improved by one small change or tool?
  

Passion and caring are the oxygen and dry wood that fuel the flames of outrage. And outrage is often what produces deep social change.

As a South African by birth, I would never have believed it possible to see the downfall of apartheid in my lifetime. As a citizen of the world, I did not dream that the Berlin Wall could come down so quickly brick by brick. Now I know better.

By harnessing your fury and channeling it into worthwhile entrepreneurial outlets, you stand a good chance of succeeding as a social entrepreneur - one who "identifies and solves social problems on a large scale, seizing opportunities others miss in order to improve systems, invent and disseminate new approaches and advance sustainable solutions that create social value." (this definition is from a PBS show entitled The New Heroes).

And being a social entrepreneur is NOT incompatible with being profitable. Look at Dame Roddick!

In her article, Dame Roddick does more than pontificate about becoming an entrepreneur. I've listed some of the wisdom she offers, from the article, to help make your business start up possible.

"Tell stories. The central tool for imagining the world differently and sharing that vision is not accountancy. It has more to do with the ability to tell a story.Telling stories emphasises what makes you and your company different. Business schools emphasise how to make you toe the line.

Concentrate on creativity. It is critical for any entrepreneur to maximise creativity and to build an atmosphere that encourages people to have ideas. That means open structures, so that accepted thinking can be challenged.

Be an opportunistic collector. When entrepreneurs walk down the street they have their antennae out, evaluating how what they see can relate back to what they are doing. It might be packaging, a word, a poem or something in a different business.

Be passionate about ideas. Entrepreneurs want to create a livelihood from an idea that has obsessed them; not necessarily a business, but a livelihood. When accumulating money drives out the ideas and the anger behind them, you are no longer an entrepreneur.

Feed your sense of outrage. Discontentment drives you to want to do something about it. There is no point in finding a new vision if you are not angry enough to want it to happen.

Believe in yourself and your intuition. There is a fine line between entrepreneurship and insanity. Crazy people see and feel things that others do not. But you have to believe that everything is possible. If you believe it, those around you will believe it too.

Have self-knowledge. You do not need to know how to do everything, but you must be honest enough with yourself to know what you cannot provide yourself."

As Mahatma Ghandi said: You must be the change you want to see in the world.

Does that provide you with any ideas?

Are physicians really THAT cheap??

I was invited to participate last night in a roundtable discussion with MBA students, from all the bigger Los Angeles schools, who were interested in entrepreneurship.

I represented the category of entrepreneurship and healthcare, and was pleasantly surprised to discover that several of the students were interested in learning more about healthcare opportunities, despite the siren call of much sexier sounding businesses like sports companies, fashion business and the liquor industry!

What stirred my juices was a question from a young man who, as a pharmaceutical sales rep now completing his MBA, had whiled away many hours in doctors' offices waiting to talk about his products. Instead of, as he put it, "reading Vogue or Sunset magazine -- the People magazines had invariably been stolen", or staring at the patients, he had chosen to strike up conversations with the office staff. In doing so, he had become aware of many of the challenges faced by physicians in private practice, as well as some of the good, and less-well performed business practices.

He wondered out aloud whether there was a viable business opportunity - figuring out ways to help physician practices reduce waste, increase efficiency and generally run more like great boutique or even larger service businesses.

It was his next observation that got me.

"Why are doctors so cheap?" he asked.

I gathered he was expressing concern that doctors wouldn't pay for the services he was considering offering.

I've heard this asked or remarked upon many times before, and I must have just dropped any pursuit of the question, perhaps because I didn't have an audience to blog about it to. Now I do - and you're it!

In trying to formulate a response, I realize that the questions behind this question need to be answered first.

Did he really mean: Why don't physicians understand that making an upfront investment in something can sometimes make them way more money later on? i.e. What do they know about Return on Investment?

Or, was he really asking: Why do doctors handle money so poorly?

Or perhaps: Why are doctors so arrogant about knowing it all and not paying for good help or advice?

Or, could it actually be: Why are doctors so miserly?

In his book "The E-Myth Physician", Michael Gerber has a chapter he calls "On the Subject of Money", where he describes the four factors of money:

   1. Income: what the doctor takes home as an employee of the practice or business
   2. Profit: what is left over after the practice has done its job efficiently and effectively
   3. Flow: how much money is there when you need it
   4. Equity: the financial value placed upon your practice or business by a prospective buyer of your practice or business.

This is, of course, a bit of an aside to my original question (just thought I'd take a moment to give you something meaty to think about!).

What Gerber says, and perhaps this is at least part of the real answer to our young man's question, is:

• Doctors have studied medicine and NOT the economics and finances of practicing medicine - they lack knowledge
• Doctors are really busy people, under a lot of pressure (getting worse all the time - my comment) - they lack the time to get educated about money
• Doctors, for the most part, don't like dealing with money - they have an emotional reaction to money
• Doctors don't think of themselves as business owners with responsibilities to teach all their staff to think like practice owners - they just want to be left alone to be a doctor and let the money take care of itself.

My reply to the ambitious and concerned sales rep MBA student was:

"Figure out what stresses the doctors most. Show them that you understand their headaches and their challenges - empathize from a sincere place of wanting to help.

Use the power of story to illustrate the ways in which your services could alleviate some or all of their most tedious headaches. Make it simple - no MBA jargon!

Intentionally design an experience that you want your customers - the doctors - to have of you and your business. Don't leave it to chance.

Share your knowledge - educate, without patronizing, because these are incredibly smart people.

And, do this with love in your heart, because it's a tough job running a practice or business in a low-reimbursement environment. By doing so, you will have created Meaning for your work - you'll be impacting not only the lives of many good doctors but also the thousands of their employees and patients".

Once you have accomplished this, I believe you will discover that physicians are not cheap - they are merely cautious. They want to trust you, because their work is, in many ways, a sacred cause.

And you must earn their trust!

Was I correct? What do YOU think?

On Becoming Published

I had mixed feelings when I opened my copy today of The Physician Executive, the American College of Physician Executives' bimonthly journal. 

I was very excited to have an article published - titled "Have Dream....Will Prevail". The article profiles the early business travails of Dr. Susan Reynolds, a former ER physician, who, almost despite herself, became a physician entrepreneur. It goes on to describe how, after a series of adverse events that caused the failure of her first business, she changed course to start and run the now successful Institute for Medical Leadership.

I was, however, distressed by the title of this issue - "Special Report: Discouraged Doctors". The report summary (it's a PDF) is a sobering indictment of a health system that is failing not only its "clients", namely patients like me and you, but also one of its main "worker" groups - the doctors! There are several other excellent articles that underline the deteriorating condition of doctors' morale, as well as those that offer prescriptions for relief.

I felt a small measure of satisfaction ("yay - I think I am on the right track" - the eternal quest for validation of one's ideas and impressions!!) when I saw the first bullet in the "Physicians Sound Off" section - Lack of Creativity! Yup - that is what I have been observing in my work as a coach, and I believe it is the sheer creative, innovative, alive-making joy of business-building that is one possible antidote to the poison of declining reimbursements, 7-minute patient visits, and onerous regulations. 

Unfortunately, the online version of my article is available for ACPE members only, but if you go to the Physician Executive Journal page here, you can signup to receive an initial free copy. I hope the one they send you is the current November-December issue, as it is filled with food for thought!  And I, for one, would love to hear your thoughts.