The Entrepreneurial MD's Podcast this week is on an intriguing and obscure topic - previously unknown to me, and to many physicians I suspect. However, it involves tax savings!

Are you an owner or even part-owner of a commercial medical office building?
Or thinking of becoming one? 
Or other commercial real estate?
If so, it's time to sit up and pay attention as this information could make you smile, while Uncle Sam frowns.

In a podcast interview with Cherie Brown of Cost Segregation Services Inc (CSSI), I learned that there are relatively new accounting regulations that permit a commercial business owner paying income taxes to accelerate the depreciation on the building, thereby freeing up lots more available cash flow each month.

From their website:

"Cost segregation is the IRS approved method of re-classifying components and improvements of your commercial building from real property to personal property. This process allows the assets to be depreciated on a 5, 7, or 15-year schedule instead of the traditional 27.5 or 39-year depreciation schedule of real property. Thus your current taxable income will be greatly reduced and your cash flow will increase."

Although this may sound like dry "accounting-ese", I hope that the idea of saving beacoup bucks is catching your attention!

In order to qualify for cost segregation, you need an engineer's report that details all the specifics of your building - carpeting, cabinetry, wall attachments, walls, floors, ceilings etc! That is where CSSI comes in - they are the engineering company that generates the report for your CPA.

The good news is that Cherie is a capable translator, who manages to make an arcane topic understandable.

Questions, anyone?? :-)

We've been in a so-called Information Age where knowledge is king, and teaching is very profitable to sell. However trend-watchers are forecasting the rise in "Do it for them" services (here is an example) given that one of our resources in shortest supply (other than gas!) is Time. Do-It-Yourself is proving costly with its learning curves and typical early-user errors.

Think frozen organic baby food delivered to your door, professional organizers, or personal shopper services.

How can you take advantage of this emerging trend as you explore ideas for a new business?

• What problems are your clients or patients struggling with that, instead of merely handing out advice, you could actively SOLVE for them?
• What solution can you offer that has generic step-by-step how-to components (in a book or e-course or audio/video program), that you can then supplement with individual customization?
  An example might be a weight loss program with generic information about getting started with an exercise routine plus illustrated information about portion control and label-reading, supplemented with weekly one-on-one phone or in-person consultations tailored to the individual needs. Not exactly doing it for them (I wish you could work off my extra 5 lbs!) - but as close as it gets!

Many of my entrepreneur coaching clients in start-up mode need to attack a list of various chores to get their new businesses or practices off the ground. For example, they might need to:

• have a business logo design created
• select options for a business identity kit (business card, letter head, envelopes, logo, banner etc)
• design a website and create the content for it
• form a legal entity
• set up an office
• hire personnel
• select their telecommunications and technology resources
• open a new banking account

This is all time-consuming stuff -- right?

So if I was paying attention to the trend, my business, which is geared to support early-stage physician entrepreneurs, might offer a bundled "start-up package" including:

• pre-screened graphic design services that would provide you with 3 or 4 design options for logos and websites based on your responses to a questionnaire, and all you'd have to do is choose.
• carefully selected web masters who would build you a 7- or 9-page website based on your initial input, and tweak it based on your feedback
• affordable copy writers who would write the content for your website and marketing promotional materials
• access to a Virtual Assistant to do all the leg-work to help you form your business entity, open our bank account, or get your office, technology and telecomm needs addressed
• access to a small selection of attorneys or CPAs who can advise you and then actually complete for you the legal entity that best meets your tax and legal needs
• all the coaching necessary to come up with a viable business model, business plan and marketing plan and to figure out the implementation plan in the stages that best worked for you

In case you are wondering, I am working on this new "do-it-for-you" package approach for my time-pressed entrepreneurial physicians, in partnership with an esteemed colleague who has many years of highly successful entrepreneurship and business coaching under his belt. Stay tuned for future updates!

By the way, if you know of anyone who can figure out my next phone upgrade - smart phone or Blackberry? which smart phone or Blackberry? buy now or wait until newer models come out? is 3G necessary? which plan? how to hook it up with my email, contacts and calendar? how to best use it? etc. - I need this done for me. Can you see why I'm tired of trying to figure it all out?! :-)

Today's startling news from the Washington Post is that the cost of medical errors has been quantified. The estimated 238,337 potentially preventable deaths of U.S. Medicare patients, between 2004 and 2006, cost the Medicare program $8.8 billion. This was according to the fifth annual Patient Safety in American Hospitals Study.

That princely sum doesn't take into account the costs of preventable deaths of patients insured under programs other than Medicare.

We're talking a lot of money! And where there are potential cost savings to be had, there MUST be an entrepreneurial opportunity for a smart group of physicians.

Given that much of the financial burden will fall on hospitals (beginning October 1, they will no longer be paid for those hospital days that accrue as a result of iatrogenic complications), I bet your local hospital will be eager to partner with an enterprising physician or group of physicians, and find a legal way to share the cost savings!

What device, or program, or approach could you develop that would help decrease the incidence of DVTs, bedsores, wound infections, post-op respiratory failure, falls, or post-op hemorrhage? (here is the list of patient safety indicators from the Distinguished Hospital Award - Patient Safety site.

It's time to put your creative problem-addressing thinking caps on -- there is an opportunity to make a substantial difference here, and hopefully profit appropriately from your "invention" as well!

I get excited when I run into entrepreneurial thinking in a physician, so I smiled gleefully when I read Dr. Richard Schoor's recent post in his Independent Urologist Blog.

As a solo practitioner "fighting the good fight", he writes that there are competitive advantages to being the small practice in a sea of big groups, and these include:

1: Flexibility — you can be flexible, adaptive, and change-ready. These are important characteristics to possess in the face of shifting reimbursements schemes, regulations, and managed care rules on top of major advances in communications and health information technologies.

His other points are (you can read the rest of the post here):

2: Cream-skimming.

3: Tech-savvy.

4: Alternative delivery methods.

5: Patient preference.

6: Regulatory changes.

To this list I would add:

• Avoid the overhead bloat
• Find and exploit a key point of differentiation (e.g. "the physician who grew up in the neighborhood and chose to come back", "The practice where your time is more important than ours" etc.)
• Act big, with an active informative website/blog that attracts not only the attention of your patient market, but that also interests and excites your local media -- PR is the BEST form of free advertising.

Good entrepreneurial analysis, Dr. Schoor!

Observant physicians who have labored at their "doctor work" deep inside healthcare organizations, or who have been active in their medical groups of specialty associations, gain valuable insights into what does and doesn't function well in these workplaces. They then often consider consulting as their next career.

A few words of warning about the pitfalls of consulting might be in order - taken from Ramit Sethi's blog, I Will Teach You To Be Rich in the guest blog post by Pam Slim (Escape from Cubicle Nation) that is titled Considering a career in consulting? Avoid these 5 stupid mistakes.

The 5 mistakes she suggests you avoid are:

• Acting like an arrogant colonist.
• Selling your words by the pound. 
• Thinking you know everything.
• Acting like a clone.
• Tying yourself to the coattails of one client.

I considered a move into consulting for a brief time, prior to discovering my real passion for coaching. And while there is some overlap between consulting and coaching, the reason I opted for coaching was to be able to stay away from having to be the Goddess Of Advising. Instead of knowing and providing all the answers, I have made it my life's work to help my clients discover their own best answers instead.

Nevertheless, there are three books geared for consultants that I deem to be the very best, because they stress the invaluable support and assistance a truly authentic consultant has to offer the right organization or group of people.

Instead of being know-it-alls, the consultants who subscribe to the approaches in these books are more inclined to be great thought partners, collaborating with their clients in search of excellent solutions.

Here's my list of most-loved consulting books:

Flawless Consulting by Peter Block, along with its Fieldbook and Companion

Let's Get Real or Let's Not Play by Mahan Khalsa

Million Dollar Consulting: The Professional's Guide to Growing a Practice by Alan Weiss, along with its Million Dollar Consulting Toolkit.

And, by the way, even as a physician in practice, you might find a great deal to chew on between the covers of these books and in Pam's blog post -- after all, you are a very special kind of consultant!