Viewpoint
Let's Not Shrink from the Challenge

FROM THE CHIEF MEDICAL EDITOR, Paul S. Koch, M.D.

Paul Cook, the founder of Raychem, said it well: "In the final analysis you can't continue to reduce costs and grow."Right now many physicians are concerned about pigeonholing expenses. So much is allotted for supplies, for salaries, and so forth. And according to the rules of business, the salary expense must shrink as gross revenue shrinks, so downsizing is inevitable. Whether by layoffs or attrition, or by using part-timers and limiting their benefits, somehow, someway, personnel expenses must drop.

Therein lies our challenge: how to "rightsize" our staffs so that personnel expenses are held in line, but we don't shrink. (Consultant John Pinto will have some rightsizing advice for us in next month's issue.) We need to be able to maintain capacity to develop programs and grow our practices. Some options are obvious; we can train staff to become certified technicians or divert staff into new adventures, like the identification and counseling of patients with ocular hypertension or Botoxable wrinkles. But we can't achieve practice greatness by shrinking. We have to deploy and reassign excess staff into programs we select to help us reach our goals.

SEE THE BIGGER PICTURE, TOO

Why? Because ophthalmologists collectively are an enormous employer, providing jobs and supporting millions of families who enhance thousands of communities throughout America.

Consider Newport, R.I. -- America's first playground. Multikazillionaires from pre-income tax days built dozens of hundred-room "cottages" filled with gold leaf and antiques. Those guys were loaded, and they gave work to tens of thousands of artisans, caterers, musicians, haberdashers and coachmen. The financial trickle down from those employees and contractors affected the lives of many more thousands whose economies depended indirectly on affluent people hiring and spending.

While we aren't in their league, we can learn valuable lessons from these cash barons. When we brutally downsize our practices by casually reducing staff for personal financial gain we not only contribute nothing to society, we sow the seeds for further decay. On the other hand, when we rightsize our staff by growing our practices around them, we enhance society and ourselves.