July 2008

May, June, and July were busy months with lots of patients. With me around – on site every day participating – the business soared. It is exciting and depressing: I love the result, but it makes me feel handcuffed. The truth is that not many people put as much into it as I do. Am I hiring the wrong people or is that just the way it is? I have some employees over the years who do put their “all” into their work, but it is not that common. I figured it in when I wrote the business plan. That is, I figured average work by an average clinician in an average environment. Somewhere I remember reading that the best business is one where work can get done with employees who are an average IQ and can do the average amount and quality of work. How upsetting. That doesn’t belong in health care, either. So, I remind myself, this is the business of health care, and I have to make the two – business and health care – work together. I carefully hire. I won’t take someone who is average in terms of his or her clinical capacity. I work to make sure there is competence in handling a group of patients in a busy setting. I won't hire someone who is average in terms of his or her interest in people. So, I expect more than average. Is that crazy? On every hire I learn something new, and the process keeps getting better. In fact, however, it is a slow process. HR Director is one of my Hats, and that means another job that is done with limited resources. I’m sure I could do better.



Over all, the background theme of July was the realization that owning and operating a business means having an enormous amount of risk tolerance; not just financial risk tolerance, though that is perfectly true. I have to be willing to risk time; that is profound when I stop to think about it. Time. All these years for this. There is also the intangible risk of confidence. Owning a business builds it up then destroys it. There is so much to tolerate in terms of mental drain, too, emotionally and intellectually. Sometimes I think if I have to figure out one more thing or solve one more problem I’ll pop. In the end, I think risk tolerance is proportionate to purpose. If I didn’t think this was a very important endeavor that affected more than me I couldn’t do it. Health care in America is awful. The longer I am in practice the more I am aware of the limitations of the medical model, starting from the education (training limited, by design, to sell drugs and do procedures or surgery) of the professionals, and ending in the education of the public – by the pharmaceutical industry and the doctors who are captured in the system. There should be a UHI on every corner.