The dermatologist who cried "Help!"

Staff that wouldn't stay, patients that wouldn't come back, high revenue but staggering expenses, this practitioner couldn't take it anymore

By David Elkins

A dermatologist in downtown Vancouver had a problem and he knew it. In the past six months he'd burned through not one, not two, but three receptionists and two practice nurses. Worse still, he wasn't certain why. "I've always had high turn over," he explained, "but nothing like this. In the past I always thought it was what I paid, or it was inconvenient for them to get here from the suburbs, or the parking was tough. When Gerta walked out on three hours notice, I decided it must be something else. I needed help to find out what."

The first call he made was to the placement service, part of a national chain, he'd been using to fill the many vacancies. "As usual, they weren't interested in my problem, all they wanted to know was where to send the applicants and where to send the bill."

Call two went to his practice accountant who'd questioned the high employee turnover at the year-end in 2002. "It's costing you a lot of money," he pointed out at the time. "It's expensive to have to keep training new people and the fees you're paying out for temp help and to employment agencies are way out of line."

Though he couldn't provide any direct help, the accountant suggested the doctor call a small business consultant he'd worked with in the past. "He's got some dentist clients," he said, " he may have an idea or two."

MEETING THE MAN
The consultant met with the doctor at his practice the following Saturday morning. The two hit it off from the start. That's important; when looking for someone to help with your practice, the first rule is you have to get along with them and feel you trust their judgment.

Here are some of the other questions the accountant suggested the doctor ask the consultant: How many similar clients do you have? How big is your firm? How do you work? How do you bill? What are your rates and will you provide an estimate of what your services are likely to cost before you begin? The doctor also asked about the kinds of services the consultant performed.

The point here is to hire someone who will concentrate on your problems and not their own agenda. Take a pass on consultants who seem to be peddling insurance, investments, software or computer systems.

LET THE CHANGE BEGIN
The fees were $120 an hour, which the derm found a bit steep. In every other regard the consultant seemed to know what he was talking about and, without being asked, left the names of three dentists who were his clients. The doctor checked two of them, on his accountant's insistence, and was satisfied with the answers he got. The consultant began his work the following Tuesday morning.

"The moment I stepped into the waiting room I could see there were problems," said the hired gun. "It was too small. It only sat about five and there were a couple of patients standing. The receptionist was behind a glass. It felt like a pressure cooker."

Over the next week, he and his associate spent about 10 hours at the practice and another three hours with the accountant. A week after that they presented their report with a series of recommendations. The report was an elaborate 12-page document that covered the practice from top to bottom.

The key findings: The practice was a highly charged place in which to work. Patient volume was high. Patient turnover was also high. Staff salaries were in keeping with those in the area. Staff morale was low. Practice revenue was high but so were practice expenses. The doctor was poor at delegation and at sharing practice objectives. He was a high-powered individual, pleasant with patients, but critical and abrupt with staff.

The recommendations: Reduction of the number of examination rooms from four to three, with the extra space used to expand the waiting room and to get the receptionist out of the plexiglas cage; more seating and improved decor. The preparation of a brochure that clearly laid out which services carried extra charges and how much they were. Follow-up letters to patients with a tip sheet to encourage trust in the care. The hiring of two full time practice nurses at 10% over prevailing market earnings, along with paid parking for all staff and possible flex time. And for the physician a course on people management.

The charge: $3,150. Was it worth it? "I have to say, the report set me back on my heels," admits Dr W. "There's a lot in it, many changes and they're going to cost money. Overall though, they've given me a view at my practice that I couldn't have come to on my own. I'll definitely use them again. Perhaps sooner than they think. I need them to help put some of this stuff into effect!"