Every medical practice has a variety of specialized team members that handle patient intake, billing, collections, office management, and, of course, the delivery of the actual medical care itself. In the best medical practices this system is continually refined and each member is carefully selected and trained to ensure that the practice runs as safely and efficiently as possible.
What many good doctors and practice managers often overlook however is the importance of the “outside” staff that supports the operations of the medical business. These outside professionals are just as vital to the success of a practice as any internal employee and must be chosen with the same degree of care. Here are five key relationships to review in your own practice:
1. A top CPA: There are wide ranges of performance and involvement by CPAs in the businesses of those they serve. Some are what I refer to as “tax preparers,” meaning they take your papers and tell you what you owe to the exact dollar. A necessary skill, but today’s economic conditions and reimbursement rates require more. You need a real “tax planner” — someone who is BOTH technically proficient at the paperwork and who is proactive about spotting and suggesting ways for you to pay the minimum amount legally possible. Which category does your current CPA fall into? Make sure they are working as hard to save you money as you worked to earn it.
2. A really great insurance agent (or two): Insurance is your indispensible first line of defense against a variety of exposures from malpractice to data breach and even traditional life and health. In many cases these needs are served by two different agents, one who handles life insurance planning for the staff and principals and another who is a property and casualty or “P&C” professional to help with liability coverage and health insurance. There are certainly many agencies that do both, but my experience with thousands of doctors leads me to believe that most are better at one or the other. I also prefer multi-line agents that have the entire universe of products available to suit my client’s needs at competitive pricing, not just one insurance carrier’s line.
3. A great lawyer(s): The plural is included because no matter what they tell you no one attorney can adequately handle all the needs that arise in a practice; at this point we lawyers are nearly as specialized as doctors. A good attorney is someone you can reach out to in a time- and cost-effective way to discuss issues, who is not afraid say, “I don’t do that but I know a guy who is an expert in that area.” Do you have a guide through this maze you can trust to get you the best help, even if it’s not from him? Look for someone who is proactive and can help identify issues and exposures, as they are almost always cheaper and easier to prevent than to fix or defend against.
4. A sophisticated financial planner: I’m fortunate to work with some of the best in the country, and all share common traits. Again, being proactive and realistic about risk, both in the market in general and in terms of being a high-risk professional, is important. Top advisors can actually help you identify investments that are tax advantaged, market-risk averse or at least hedged, protected from outside liability by law (like life insurance and annuities in many cases) and will identify which good investments need protective wrapper like a limited partnership to hold them safely. They will also, in conjunction with your CPA, identify opportunities to reduce taxes and allow to safely and predictably keep more of everything you earn by examining the costs and benefits of things like defined benefit plans and other legal tax deferment strategies.
These four categories form the absolute core of any well-crafted external support team, but many other professionals and relationships are required. It literally can take a village depending on the size of the practice involved. For help in identifying other areas of planning that need to be addressed, please see my previous two-part article, A Doctor’s Self-Exam of Legal and Financial Essentials.
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