Dr. Albert Fuchs is an ethical purist. That much is clear from our podcast interview today in which the Beverly Hills internist shares his views on his transition from an overworked less-than-satisfied traditional medical practitioner to a streamlined, calm, happy doctor with no immediate plans to quit his concierge practice.

At a patient's urging, he explored the concierge or retainer practice model, discovering its many variations. And realizing that, by cutting back dramatically on his patient load, he could once again become the real physician he had dreamt of being in his medical school days.

Seeking the mentorship of a family member with business experience, he began the transition several years ago by severing ties with the healthcare insurance industry, first with the PPOs and a year later with Medicare.

Paradoxically, he argues that, instead of contributing to the creation of primary care shortages with this model of care, he sees that students considering medicine as a future career are more likely to consider primary care when exposed to the role models of contented physicians providing the care they most enjoy giving to their patients! As opposed to the image many are witnessing today of harrassed, irritable doctors rushing from patient to patient, handling 5 phone calls between rooms, in order to make their "quota".

His advice:

• decide on whose behalf you are truly willing to work and who your customers really are - insurers or patients?
• take the high road and offer only those services and that care that is evidence-based. Keep it ethical - only offer what you would have done unto you!

Listen to The Entrepreneurial MD Podcast with Dr Fuchs's refreshing account of how he chose to re-align with his deepest professional values, in his quest for his vision of an ideal practice.

And then rejoin us here for your comments and opinion!

I suspect that any one or more of the following are flaring up:

1. Difficulty with tolerating the unknown: As physicians, we necessarily require a low tolerance for uncertainty. It is what urges us to relentlessly pursue the diagnosis until it is known. This attitude, however, costs us dearly when it comes to exploring options that affect our lives and livelihood.
   
2. Risk-aversion: Perhaps this originates in our choice of profession and the self-selection involved. Medicine is generally thought to be a "safe" career with a guarantee of employment.
   
3. Habitual thinking: We get lazy in our thinking - habits are easier to adhere to than to break.
   
4. Lack of confidence: It's hard to picture a physician truly lacking confidence as the demands of the career require a certain level of self-esteem. Instead, what I think what is at play here is a concern about not making the perfect decision. The one we know is absolutely right for us and guaranteed to produce a successful outcome.
   
5. Avoidance of taking responsibility: This is where we get to play the victim of our circumstances and sidestep the challenge of taking ownership of our lives and choices.
   
6. Confusion: A truism is that the confused mind always opts for "no". It's the safest way out of a mental challenge.
   
7. Expectations: This is on a par with habits. We get used to having our expectations met at a certain level -- financial, lifestyle, social, psychological -- and it is uncomfortable imagining living with anything different or less.

The unifying emotion in all seven circumstances seems to be fear!

Well then, how can one overcome fear, and create enough mental and spiritual space to foster the opposite - courage? 

In this article on positive psychology and courage from PsyBlog, "How to Build Courage Through Personality Traits and States of Mind", the author British blogger Jeremy Dean reviews a new model of courage and offers suggestions as to how to increase the positive factors that promote courage.

The factors from the blog post are (I encourage you to read the article for details as it is very helpful):

Courageous character traits

1. Openness to experience.

2. Conscientiousness.

3. Core self-evaluation

Courageous states of mind

1. Self-efficacy.

2. Means efficacy.

3. State hope.

4. Resilience.

Convictions and social forces

1. Inner convictions.

2. Social forces. 

My take on how to overcome the negative forces is to do what one client has opted for:

• work hard to set up a situation that allows time for reflection, thinking and for simply being.
• be willing not to know immediately
• trust that the subconscious and conscious minds are deeply engaged with the questions that matter
• find a "thought partner" who is equally comfortable sitting with the unknown and doesn't feel impelled to do the "doctor" thing and rush in and fix it
• become a doodler, journaller, list-maker, vision board creator. If you have to do something, let it be unstructured, random, irrational
• get physical - ride a horse, go for long walks, do yoga, jog, go kayaking

When you are feeling stuck, what works for you?

Turns out, it's an article on creativity and innovation.

What gave it lustre for me was the neuroscience about neural pathways that I've been increasingly aware of, and that very much pertains to coaching:

'... it seems antithetical to talk about habits in the same context as creativity and innovation. But brain researchers have discovered that when we consciously develop new habits, we create parallel synaptic paths, and even entirely new brain cells, that can jump our trains of thought onto new, innovative tracks.

Rather than dismissing ourselves as unchangeable creatures of habit, we can instead direct our own change by consciously developing new habits. In fact, the more new things we try — the more we step outside our comfort zone — the more inherently creative we become, both in the workplace and in our personal lives.

... “The first thing needed for innovation is a fascination with wonder,” says Dawna Markova, author of “The Open Mind” and an executive change consultant for Professional Thinking Partners. “But we are taught instead to ‘decide,’ just as our president calls himself ‘the Decider.’ ” She adds, however, that “to decide is to kill off all possibilities but one. A good innovational thinker is always exploring the many other possibilities.”'

I emphasize the phrase in the last paragraph to highlight just how our brains are trained to work as physicians. In our quest for a diagnosis, and an explanation for a set of signs and symptoms, we effectively kill of all differential diagnostic possibilities until we get to the One Answer that explains our observations and the patient's experience.

In effect, we are necessarily "anti-creative" in our trained medical thinking.

The challenge for entrepreneurial physicians then is to overcome the tendency to be reductive thinkers. Entrepreneurship demands significant creativity. We physician entrepreneurs need to see more opportunities, not fewer. To generate more ideas, create a greater number of options, or ways to skin a cat.

According to the article, researchers in the late 1960s discovered that humans are born with the capacity to approach challenges in four primary ways: analytically, procedurally, relationally (or collaboratively) and innovatively. At puberty, however, the brain shuts down half of that capacity, preserving only those modes of thought that have seemed most valuable during the first decade or so of life. (emphasis all mine)

We are stuck with how we were encouraged and naturally inclined to think.

The good news is that we can still innovate and create, despite our inherent limitations. It seems the trick is to push ourselves out of our comfort zones.

This interesting article goes on to describe:

"...three zones of existence: comfort, stretch and stress. Comfort is the realm of existing habit. Stress occurs when a challenge is so far beyond current experience as to be overwhelming. It’s that stretch zone in the middle — activities that feel a bit awkward and unfamiliar — where true change occurs."

When we stretch ourselves and expand our possibilities is when we feel truly alive. That belief lies at the heart of a great coaching relationship.

Markova, a PhD executive change consultant and author of "The Open Mind" is quoted as saying:

“You cannot have innovation,” she adds, “unless you are willing and able to move through the unknown and go from curiosity to wonder.”

I couldn't agree more.

What do you think?

This "bad day" video

May it bring a smile to your face.

BTW - this is what is called a "viral video". Something people are entertained by and want to pass around. The secret to it being effective as a marketing tool is if your message is linked in some way to your solution and prompts people to want to learn more about your business. I, for one, immediately checked out glumbert.com!

And just in case you are considering opting for a more humane lifestyle as a physician, you are in good company, according to this Wall Street Journal online article!

Answer: A powerful guiding vision.

Dr. Richard Schoor is a Smithtown NY urologist who, relatively early in his practicing career, has already accomplished three great things as an entrepreneurial physician:

1. He has built a solo specialty practice, with the guidance of his own Grand Vision, and is en route to the much bigger dream
2. He has carved out a niche for himself as a male infertility sub-specialist, in a crowded field, thereby turning his potential competitors into a source of referrals
3. He has begun building a web presence and "platform" for his name and practice using 21st century marketing tools, and has already reaped the benefits. He is the author of an acclaimed blog -- The Independent Urologist.

Since I teach and encourage each of these principles, in my eyes that makes him an up-and-coming star entrepreneurial physician business owner!

Listen to Rich Schoor MD tell his story of how he escaped the "safe" trap of group practice, and opted instead for the elation of independent solo practice (it's less than 20 minutes).

And then please rejoin us here to share your thoughts and questions.

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?! :-)

Andy Oakes-Lottridge MD

As one of the growing number of physicians with concierge or membership-style medical practices (known to some as "boutique practices"), he opened his doors (actually the doors of his Honda Accord car) almost three years ago after recognizing some significant limitations to traditional group practice.

However, instead of opting for an office-based practice, he has chosen a practice in which 100% of his patient visit are home visits. Talk about keeping overhead down!

At The Entrepreneurial MD Podcast, you can enjoy his refreshing story and appealingly candid insights about life as a concierge home-visiting doctor in Fort Myers in the Southwestern part of Florida, and then rejoin us at here to add your comments or questions!

Joshua Schwimmer MD over at The Efficient MD has put together a comprehensive overview of the appropriate use of patient-physician email. He speculates as to why medical practices and healthcare organizations are late adopters of email as an efficient means of communication, and then suggests some ways that email may be used:

• Asking about lab results
• Reporting potential side effects of medications
• Clarifying whether it's safe to take a certain medication
• Reporting home blood pressure readings
• Reporting blood sugar readings
• Giving positive feedback
• Giving negative feedback
• Asking for prescription renewals
• Reporting new minor (but important) symptoms
• Communication new medical issues when out of the country
• And many others

I enjoy being able to communicate with my own physician using the RelayHealth platform, and am usually delighted to get a quick response. It certainly saves playing phone tag.

Dr. Howard Stark, in a recent Entrepreneurial MD podcast, sang the praises of his tranquil office. His receptionist's phone seldom rings, as most of the communication with patients is handled via his "invention" - a web-based encrypted, HIPAA-compliant virtual office now available to other practices from DoctorsOnTheWeb.net.

Check out the brief MSNBC video with Matt Lauer and Dr. Nancy Schneiderman on Dr Stark's site! They discuss the future of email in medical practices.

What are your thoughts?

Yesterday I came across a new resource on the Web, Medical Career Change, that appears to be a handy compilation of articles, websites and tools for physicians considering a change of career.

The author or authors don't seem to be identified and the blog describes itself as "a directory of resources for doctors interested in investigating non-traditional (clinical or non clinical) career paths".

The blog categories are:

• General advice about changing careers 
• Career resources
• Adventure medicine
• Crowd doctor
• Cruise doctor
• Investment banking
• Law
• Management consultancy
• Media
• Medical relief
• Medicine overseas
• The armed forces
• Pharmaceutical industry
• Other options
• Career change conferences

Crowd doctor??? Well, that's a new one for me!

I was pleased to see that SEAK's 5th Annual 2008 Non-Clinical Careers for Physicians Conference (October 4-5 2008 on Cape Cod MA) was listed -- I am honored to be an invited keynote speaker there, talking on the topic of "Career Shifting for Physicians: How to Ease the Transition". And then I get to be "roaming faculty" available for mentoring and offering whatever insights I have to share.

If you are a physician contemplating a career change, please come and join us in beautiful Cape Cod in the fall! I'd love to meet you in person :-)

If so, you are most likely encountering Creative Resistance!

According to "Demystifying Six Sigma: A Company-wide Approach to Continuous Improvement" by Alan Larson (thanks to my business coaching program leader Adam Urbanski who reminded us of this today),

Vision + Skills + Incentive + Resources + Action Plan = Success

On the other hand, 

            Skills + Incentive + Resources + Action Plan = Confusion
Vision            + Incentive + Resources + Action Plan = Anxiety
Vision + Skills                 + Resources + Action Plan = Procrastination
Vision + Skills + Incentive                   + Action Plan = Frustration
Vision + Skills + Incentive + Resources                    = False Starts.

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

Creative Resistance occurs to even the most motivated and enthusiastic entrepreneurs. There are days when our energy is low - it happens to all of us.

This Resistance only becomes a problem when it becomes the Habit.

To overcome your inner struggle, here are seven tips to managing yourself more effectively:

1. Set deadlines (Action Plan)
   If you want to complete a project, such as decide what business to go into, or leave your practice, or finish your audio information product, a deadline will get you fired up. Go public with it - let others know of your drop dead date. Committing in this way will avoid the wishy-washyness of a soft and infinitely mobile due date.
   
   
2. Strive for clarity (Vision)
   Develop your plan and know your business or project model. Do not allow yourself the distractions of items, offers and requests that do not support your plan or business model. Understand your "big picture". Then create your plan in a way that dictates the action steps to be followed.
   
   
3. Create Action Lists (Action Plan)
   A huge action list can be a source of overwhelm, procrastination and discouragement. Instead, maintain a "master list" (keep it tucked away but accessible) and extract from it each day or evening those five or six high priority tasks to accomplish. Keep this much smaller list handy - on a 3 x 5 card, PDA or planner and check off each completed task.
   
   
4. Get enough rest (Resources)
   Your energy is one of your finite resources (just as time is). Guard it fiercely!
   
   
5. Be accountable (Incentive)
   When we go public with our plans, even if it is to one other person, we tend to hold ourselves to a higher accountability standard. Find a mentor, join or create a Mastermind group, involve a spouse or partner (carefully, so as not to cause friction in the relationship) or hire a coach. Request that they be the person to whom you will be answerable for getting things done. 
   
   
6. Make time obvious (Resources)
   When we pay attention to how we use our time, we tend to be more frugal about wasting it. Especially when we know what each hour or minute is worth. I recently used a timer for two days, to see how long my various administrative activities were taking. After the shock wore off, I assigned a bunch of new tasks to my virtual assistant, and have a search on for a bookkeeper.
   Use a scheduler, and set up regular cannot-be-canceled meetings with yourself in a highly visible way on a calendar, to accomplish your projects. Some years back, I instituted a weekly Business Development day (exclusively to work ON my business), and my productivity and results have soared. 
   You must become a master of saying "no" - to immediately responding to emails, to answering the phone when it rings, to permitting others to interrupt you for anything non-urgent.
   
   
7. Be organized (Skills)
   It is hard to get anything done with a messy desk and a huge effort required to retrieve any needed papers or documents. And what about your Inbox with its 400 emails?
   Get organized by devoting your first few hours to setting up systems to:
   a.) deciding what needs to be kept, given away or thrown away,
   b.) giving everything you are keeping a designated home
   c.) developing a systematic way to find the items in future.

And if you are still battling Creative Resistance, I highly recommend "The War of Art: Break Through the Blocks and Win Your Inner Creative Battles" by Steven Pressfield.

It all comes down to Discipline - defined as what you need to rely on when the emotional excitement and newness of the project has fizzled and you are left with having to take action!