How you can win ... with a losing lottery ticket.

Stopping for gas and a coffee at the start of a 45-minute commute to my office one day, I decided to pick up a lottery ticket. After all, the jackpot was more than $300 million and “you have to play to win.” As l resumed my drive, my mind wandered to the crisp new lottery ticket in my pocket. This sparked a thought experiment that would change my career forever: What would I do if I won the lotto?

My first thought was to pay back student loans for myself and also some friends and family. Then I began to think about using the winnings to open a second office near my home so that perhaps once or twice a week I could decrease my commute and work in the community that I actually live in. This idea occupied my mind for the remainder of my drive. By the time I’d reached the office, I had come to the realization that the plan would work … even if the lottery ticket was a loser (it was).

FIRST, MAKE THE TIME TO PLAN CHANGE

Ideas for improving or expanding your practice often get lost as you deal with the day-to-day chaos of patients, staff and operations. You can’t see the big picture if all your time and energy are spent putting out fires. Even if you meet with your team on a regular basis, those meetings are typically consumed with discussing the recent past or near future.

It is mission critical to actively set time aside to contemplate and create significant or disruptive change for your practice. It is not always easy to do this. Still, make time; find the best mentors or like-minded people and set out to find the next best thing or strategy.

Without allocating this time, you may organically grow but remain stuck in the practice already created. A key mantra to guide practices leaders:

You need to work on your practice rather than for your practice.

STAY TRUE TO THE PROCESS FOR GROWTH

A common pitfall of practices that have experienced some growth is to fear failure, so they avoid risk and instead continue with what worked in the past. But this response means you ignore the business acumen that led to your success. I urge you to stay true to the process for growth rather than the growth itself.

The best way to develop strategies is to copy ones already successfully implemented by other practices. There is no prize for being original. Use your energy to duplicate best practices; focus on how and when to best implement a change into your practice. To gather new ideas, actively seek them out. Travel to offices or surgical centers. Most great ideas are mimicked and then adapted to fit one’s own practice style.

Create an opportunity for discussions to generate ideas in your own practice, of course. However, sitting in a board room, a partner meeting or trying ideas out on colleagues you pass in the hallway are not ideal settings for this. Often, the group is too large to arrive at a consensus, there is a toxic personality that never wants change or you get agreement but no meaningful action plan.

This is why finding mentors or practices that have already implemented your idea is the best strategy to create a business plan. When reaching out to these doctors or managers, you will find that they enjoy talking about the successful changes and the obstacles they endured and overcame in the process.

HERE’S HOW IT WORKS

Let’s look at how these principles can be applied to my long-ago lottery-ticket commute. Upon arriving at my office 45 minutes later, I contacted a colleague who had three locations and asked her how she grew over time.

After this conversation, other things triggered further research and considerations. This included understanding that growth would mean management of more staff and doctors over time.

This prompted me to take a hard look at the demographics and market saturation of the new proposed office near my home. As a medical surgical practice without optical or routine care, this model would be novel for this area and would create a significant new resource of potential referral sources.

Armed with this insight and some research, I could create a brief business plan, including projection numbers placed into an Excel spreadsheet. Next, I set up a 2-hour meeting with my partner to present and further expand the proposal for growth. Once he reviewed the plan, he was on board and offered many ideas to drive the concept closer to reality. Six months later, this new office was open: small in size with two exam rooms, the field machine in the closet and testing equipment mixed in with the waiting room ... but it was open.

MEDICINE VS BUSINESS

As physicians, we learn our decision-making process during training; once that training is completed, peer-review studies play a large role in our process. Any impactful change in decision making is slow and supported by data. We strongly dislike grey areas or deviating from the standard of care in our community; this mindset is deeply ingrained thanks to our education.

However, once in medical practice, the physician or managing team sometimes needs to step outside of this comfort zone and act on instinct and hunches to make significant, disruptive changes. Business strategy should trigger an awkward feeling of risk and uncertainty of success; but learning to trust your instinct — an instinct that is as well-informed by data as you can make it — is your superpower. When you do this, you are not feckless, uncalculating or brash. Simply put: “Always trust your gut. It knows what your head hasn’t figured out yet.” This trust builds confidence to act when applied to business decision making. After all, your instinct is the sum of all your subconscious observations and experiences, which then drives a conscious interpretation and action.

CHANGE HAPPENS

It has been 14 years since my daydreaming drive with the soon-to-be losing lottery ticket in my pocket. My “new” office started as 1,200 sq/ft. Six years later, it moved around the corner to 11,200 sq/ft and now includes a surgical center. The visual field is no longer in the closet, and testing equipment has its own area. This location now accounts for 65% of the practice’s revenue.

Things always change. A lot. I am no longer able to easily buy a lottery ticket because that requires cash; I no longer carry cash, only electronic funds such as Apple Pay. Also, I no longer even go to gas stations since I now charge my car at home. So, embrace change. It is the process that got you where you are and keeps your practice evolving. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.

Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.