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Publishers Note: Up By His Bootstraps


Elias Sanchez, a 40-something general practitioner, became a doctor the hard way.

I met Sanchez at the Pri-Med West meeting in Anaheim, Calif., while standing at the Physicians Practice booth on the trade show floor. He is outgoing, confident, and curious, and we quickly struck up a conversation.

What I learned from our talk reminds me that despite the doom and gloom that often permeates discussions about the future of medicine in America, primary-care and family practice physicians can lead independent, financially viable businesses if they take the business of their practice as seriously as they do the health of their patients.

The son of two migrant farm workers, Sanchez was a rather middling student, receiving mostly C’s and D’s in high school. After graduating from high school, he went to work as a laborer in the furniture business.

It didn’t take long for him to realize that he wasn’t getting anywhere toiling away in a furniture factory. He decided to go back to school, enrolling at a nearby community college. That’s when he made a second realization, that his previous education had left him ill prepared. He had to re-do high school.

At around the same time, his mother was diagnosed with cancer, from which she died. He decided that he would become a doctor, in part as a commitment to his mother’s memory.

So there he was, a young man with a dream to become a doctor but without the academic training.

Sanchez sought out a classmate who routinely produced A’s. He asked if he could shadow him and see how he did it. Watching this successful role model, Sanchez saw what was required. After each class, his role model would go straight to the library, quickly rewrite his notes, then go back and outline the key points covered, and in the process commit his professors’ lectures to memory. Sanchez employed the technique, and his grades improved. Ultimately he made it to medical school and completed his residency at the age of 30.

After completing his training, Sanchez joined a private practice. He realizes now that while he may have been adequately trained to care for his patients, he lacked the business skills necessary for private practice.

Joining the practice, he gave up all control over the billing and collections, deferring instead to the office manager. But he soon felt that while he was providing his patients top medical care, the amount of his effort did not translate into higher compensation. “I kept working harder and harder,” but didn’t produce much more income, he says. In hindsight, he realizes, he only had himself to blame.

In November 2004, Sanchez reached his breaking point and left to form his own practice. But with no training in business, how could he survive?

With no role model to emulate, Sanchez this time studied the money supply of his practice, tracking how cash came in and how it went out. He took on all the responsibilities frequently handled by an office manager.

He learned how to balance great patient care with great practice management.

Recently he hired an office manager. He sees 19 patients a day on Mondays, Tuesdays, and Thursdays. He dedicates Wednesdays and Fridays to accounting and spending time with his family.

The payoff all of the hard work has been huge. His dad, Sanchez says, gets to introduce him as “my son, the doctor.”

Ken Karpay is the publisher of Physicians Practice. He can be reached at
This article originally appeared in the July/August 2007 issue of
Physicians Practice.

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