What a rubber band can teach you about running a practice

Think about all the uses of a rubber band. The one thing they have in common is that the rubber band is only useful when it is stretched. That is also true for developing and growing a medical practice.

In the summer of 1960, I had my first job as a dishwasher at a local college during summer school. I was paid the minimum hourly wage. My assignment was to scrub and clean pots and pans. Since this was my first paid job, I was eager to demonstrate my energy and enthusiasm. I was able to complete my dishwashing task in less than two hours and sat down and looked at a magazine. (There were no cell phones or hand-held video games at that time!) The kitchen manager asked, “What was I doing?” I told him I finished my job. The manager then told me to polish the silverware. I completed that task very quickly, and he then sent me home; I was only paid for working three hours. I did not need to be a time-and-motion expert to understand that I had to work more slowly to increase the hours worked and increase my income.

So, what does this have to do with the practice of medicine?

The working hours in my practice were 8 a.m to 5 p.m., and the staff always stayed until 5 p.m., even if they had finished their workload before QT, i.e., quittin’ time. One of the problems we had was controlling the three to five no-shows that might occur each day. We had the receptionist call patients at home 24 hours before their appointment to remind them. We also took the names of patients who wanted earlier appointments if slots became available. These were patients who were willing to come in on short notice. On several occasions, there were open slots in the schedule, and I asked if patients who were willing to come in on short notice were contacted. The answer was almost always that the waiting list was not used, and yet the staff was doing unproductive work waiting for five o’clock. Reflecting on my days as a dishwasher, I told the staff that if they could fill the no-show slots by using the waiting list and complete the work, they would be permitted to leave before 5 PM. Voilà, all the holes in the schedule were filled, and the no-show problem was solved.

Another practice was having issues putting patients in the rooms at 9:00 a.m. to start the clinic schedule. The doctors blamed the staff for not moving the patients into the rooms at 9:00 and the staff blamed the doctor for arriving after 9:00. The office manager, the nurses, and the doctors had a meeting, and they all agreed that patients would be advised to arrive at 8:30-8:45, and the doctor would also arrive at 8:45 and now the schedule commenced at 9:00 and was kept on track for most of the day.

Recently, several companies offered a four-day workweek after noting a decrease in productivity on Fridays, especially Friday afternoons. Microsoft in China offered a four-day workweek and reported a 40% increase in productivity. Perhaps this could apply to medical practices. How? The staff could work 10-hour days, four days a week. Friday would be used for surgery, especially Friday morning, and if the surgeon finished early, they, too, could go home early, spend time with the family, and be home for dinner.

We should reward our staff for being efficient, not for making the job take longer. Keeping staff on when all patients have been seen and all tasks have been completed motivates them to act like the teenage dishwasher and work more slowly to increase their hours.

Abraham Maslow, a psychologist famous for his hierarchy of needs, stated that “If you deliberately plan to be less than you are capable of being, then I warn you that you’ll be deeply unhappy for the rest of your life.”

Unfortunately, physicians often become comfortable in their comfort zone and accept the status quo. I have experienced this when I moved from my training in Houston, Texas, to a practice in New Orleans, Louisiana. I had training and skills that were different from what was usual and customary in my new practice. It was the late 1970s, and I wanted to introduce the use of prosthetics in urology, i.e., the inflatable penile prosthesis and the artificial urinary sphincter. My new ideas met with resistance, and I heard the comment, “Not invented here.” It was suggested that I accept the status quo.

Physicians are highly educated and know about the benefits of deferring gratification. For the most part, they don’t enjoy being average. Being successful and growing meant breaking out of the comfort zone and accepting a mindset of just being average. I wanted to be more like a rubber band, to stretch and leave the comfort zone. When I learned to approach change slowly and avoid introducing radical change, I was able to implement these new concepts and treatment modalities.

Bottom Line: Growth and success in a medical practice are to learn from the rubber band metaphor. If we embrace the tension of leaving the comfort zone, we can go from where we are to where we want to be. This allows us to differentiate ourselves from our peers. It just requires embracing change and enjoying the stretch. Success is not obtainable when you lose that tension between where you are and where you could be.

Neil Baum, M.D., is a professor of clinical urology at Tulane University in New Orleans, Louisiana. Dr. Baum is the author of several books, including the best-selling book Marketing Your Medical Practice: Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.