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Prepare Your Practice for What If Scenarios


No one plans on getting seriously ill, but it happens. This MD says practices should learn to prepare for these scenarios, just in case.

No one plans to get ill, but at one time or another it happens to all of us.  Usually, it’s just a cold or sometimes the flu.  If it's more a serious medical diagnosis, someone is likely to retire or take disability leave. However, what happens if you get struck with an an illness and condition that doesn’t qualify you for disability but definitely has an effect on how you are able to work?

I have been in just this category for almost a year now. About a year ago, I became symptomatic with POTS: Postural Orthostatic Tachycardia Syndrome.  Fortunately, I do not faint like most people with this condition. POTS is caused by pooling of blood volume in the lower half of the body and the sympathetic nervous system not telling the circulatory system (blood vessels) to contract in order to push the blood back up.  The heart has less blood to pump to the brain and it causes pallor, shortness of breath, and confusion due to the decreased oxygen delivery.  Imagine that you live at sea level and go to a mountain above 8,000 feet; or think about climbing Mount Everest without supplemental oxygen.  This is what it feels like when I have an episode.  Fortunately, when my symptoms flare, they resolve quickly if I sit or recline for a bit.

It took a few months for me to get a diagnosis and get treatment adjusted. I was out for about two months and initially returned to work part time.  To see patients, I “walk” around while sitting in a wheel chair and put my feet up on a stool in the exam rooms. I can stand and walk, just not for long periods of time.

I am still in the discovery period as to just what and how much I can do. I have had setbacks where my symptoms get far worse.  The good news is that in the past two months, my symptoms lessened.  I’m not sure if it is just one modality of treatment or all of the lifestyle changes I’ve made.  I am striving to increase my patient care hours and only time will tell just how far I can push myself without going too far and having a setback.

Anyway, back to the practice.  I am the most senior partner in our group.  I have been in the same pediatric practice for 23 years now and have been through two events that had the potential to completely annihilate us.  My group has gone from three physicians and two office sites to our current iteration, 10 physicians and 5 midlevel providers, and we are planning to open our fourth office this year.  I thought I had full support from my practice but unfortunately my five partners are losing patience. We had a particularly difficult meeting a few weeks ago that created even more tension between us. There are likely more challenging discussions to come.

Sadly, all this could have been prevented! In forming the exact wording of the partnership, we naturally discussed retirement, death of a partner and removing a partner from the practice. We did not, however, discuss other situations of medical illness or partial disability.  I see now that we really should have explored and planned for these possibilities beforehand rather trying to react to the current situation.

As such, here is my advice.  1: Have discussions with your partners to explore the “what if’s”.  Even if you don’t come up with concrete plans, at least it won’t come as a surprise. Write it down and revisit as needed, but do this at least yearly.  Also consider if you will have different levels of adjustments for senior versus junior partners or will you make it equal for all?

2: If you find your practice in a situation like this, start communicating EARLY! Don’t let hard feelings develop between you as it turns into a larger crisis. Most especially don’t have an intervention style group discussion with the physician in question. Pick one spokesperson to handle the communication.

3: Get a mediator involved as soon as possible.  This will help keep emotions stable and encourage the focus to be on the business. 

4: Don’t lose hope! A partnership that has been in place for a while has a stable foundation, even if it doesn’t seem like it at the time. Most difficult situations can be salvaged with patience, understanding, communication, and adjustments.

Good luck and I hope you all stay well!

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