Provided by:  Jennifer Kirschenbaum, Esq.
December 26, 2018
At the start of 2018 I committed to provide a bit more commentary and general advice in this forum from time to time, and as we see the year come to a close, I am using today's newsletter as a platform to discuss an opportunity we each have to help maintain the integrity of practice in our everyday, as well as during major life changes such as a job change. This year I sat front row to the corporatization of practice in our community - moreso than any other year I have practiced law.  For certain client representations I could not be prouder of the result of such process; seeing quality as the metric heralded above all else, with practitioners leading the charge and setting the standards.  This is not the case in all constructs.  Certain players in healthcare are not quality driven, but instead solely cost and revenue driven.  Being a part of such a construct doesn't mean we can't win the day to day battles related to qualify of care....

The discussion I wish to raise today is not for the power of the CEO, but the power of the individual provider who may already be a part of an existing corporate construct, or considering joining one.  For many doctors the time to sell and receive a windfall for what you have built over the years is now.  Value has somewhat returned to the market because of the corporate forces sniffing around.  Finance opportunities are lower on the radar for investors as a result of market conditions, retail is in the middle of a major restructure, so where is the money flowing consistently in the marketplace?  Healthcare.  Private equity and other investment vehicles are going bananas over opportunities to take the helm or a sliver of medical platforms, or the real estate same sit on.  

On the front lines, we all have choices to make when we think of our day to day.  Autonomy, control and professionalism are three principles we decide to either protect as priorities, or allow to slip from us in exchange for other priorities, like a better buy out price.  NEWS FLASH:  You do NOT have to compromise on professionalism for value! Every deal I am a part of - whether its for employment, purchase or sale, $ (salary, sale price, etc) is set first, at the start of the conversation.  Choices or discussion points that will impact quality - your autonomy, control and professionalism - all come after the price is mostly agreed upon.  If you and your team do not push for your autonomy, control and professionalism, these principles will NOT be protected.  You can make a difference in the model you join - you can protect the integrity of your practice by forcing issues of autonomy, control and professionalism. 

Let's get granular and skip any more build up.  This is not intended to be a 12 step self-help guide!  So, here it is, my 2018 Thesis -

As Individuals, we make up the whole.  If each of you decides to protect and fight for your ability to collaborate with colleagues, regardless of employer, protect your right to determine proper course of treatment, set reasonable limits on patient encounters per day, protect your right to dictate staffing levels around you for proper support, protect your right to select the supplies you prefer to use - we, as a community, will win on quality. Demand adequate reimbursement for CME, and attend and demand the CME that will best enable you to practice from your specialty and local associations.  Collaborate.  Collaborate.  Collaborate.   And, for heaven's sake, if you exist in a model that has taken the doctor's lounge away in lieu of providing a hang out for device reps, please lets start a mutiny. Do not stand for corporatization diluting your right to practice as you would like. We compromise a little, and then a little more, and then a little more and before we know it, we've gone from 2 MAs to 1 NP who can, by law, pretty much replace us with a fraction of the training.  We no longer have the sutures we prefer.  We are seeing 10 extra human beings a day and we no longer have time to perform a proper visit if we wish to meet our metrics and see our families.     

2019 will be a year of opportunity, from my vantage point.  You have choices.  Protect your autonomy, control and professionalism.  We can foster an environment where the doctor dictates care and control. This message also extends to professionals devoting their careers to aiding doctors in their practice - the healthcare attorneys, accountants, consultants, etc.  Too many times I see colleagues trading easy items during a transaction rather than digging in and fighting for those day to day victories.  I had several transactions this year where Selling attorneys spent time focusing on all business terms and completely ignored quality of life and control issues.  Once you start discussing quality of life, or thinking of quality of life, priorities in a deal change dramatically.  We start at the purchase price, but when we get further down the road we realize, oh yes, how I spend my time is important; where I work, how I work and who I answer to and for what, matters.  

The details matter.  The details impact you daily.  The details impact the construct, patient care and the new reality in process.   We can win on quality (for your day to day and for the community in general) if we work together and each (as individuals) seek to win on the details. 

Wishing you and your families a wonderful New Year!