Medical Practice Builds Profitability Post COVID-19

Medical Practice Builds Profitability Post COVID-19

Issue: Medical practice needs to build a an efficient and profitable organization post COVID-19.

Significance: A viable exit strategy for the business owner due to personal family complications

Background: Started medical practice 2003 with husband as President. Husband just saw patients and did not provide any operational oversight. 2009 transferred all legal ownership operational oversight (President) while seeing ¾ of patients.

  • 2013 hired additional physician who was their neighbor as business had recently doubled after actually following an industry management system they had since 2011 as needed to get revenue up to hire additional personnel.
  • 2018 moved to a 5000 ft.² facility Practice ran smoothly through the summer of 2018 with 4 doctors on staff. Owner/President was traveling nationally having published a book outlining her success speaking at conventions.
  • July ‘18 she unexpectedly ruptured a cervical disc and lost use of arm which left her unable to travel or run practice.
  • August ‘18 fired female assoc. and came back to work early.
  • October ‘18 added an additional office. Blew disc worse 2 weeks later. Out until 2/2019 and wasn’t really “with it” due to pain. Patient visits fell from 2000 to 1200 per week.Toxic work environment due to putting others in charge as owner was incapactitated who did not have same values or leadership.
  • Expansion plans focused on hiring doctors to run satellite offices and assume operational responsibilities and see small handful of patients Most stressful was repairing toxic culture.
  • 22 on team.

Actions Taken: 2019 consolidated team and fired to maintain culture. Reducing from 22 to 12. Pandemic (2020) necessitated an additional reduction to 8.

Hired multiple outsourced operational resources (administrative, financial (accounting): Was unsuccessful.

Hired industry management consulting firm, 2011 to present, to assist in achieving growth goals. Currently 20 hours per month. Have established industry targeted KPIs.

Staff huddles twice daily and has weekly team and doc meeting.

Had personal assistant – spent 50% of time in office and 50% managing home – stole from her while she was injured and erased all Standard Operating Procedures (SOP)s. Replacement was fired 7/19 for insubordination.

Have extensive written job descriptions and SOPs.

Participated and graduated from Goldman Sachs 10K SB program 2019.


  • Have not had an office manager since 13 year employee left for more money.
  • Staffing struggles and turnover.
  • Disrespect for management
  • Disregard for SOPs and systems in place.
  • Drama in the workplace- finger pointing – daily huddles turn into “bitch” sessions and avoiding responsibility.
  • Patient complaints about lack of communication with insurance.
  • Desire to make everyone happy
  • Working 16-hour days
  • When and how to discipline vs punish poor behavior
  • Bad reviews on social media from team not being meticulous.
  • Employees reluctance to accept responsibility.

Desired Results:

  • Hire engaged key staff to assume administrative, accounting, and patient experience roles.
  • Increase profitability
  • Staff buy-in to policies and procedures.
  • Improve work/life balance
  • 9-year plan for operational exit strategy.


From a behavioral assessment you are a “Visionary” and need an “Integrator” to complement you. Conduct an anonymous survey of your staff limiting the survey 8 – 10 questions. Use survey monkey.
Your expectations are based upon an old school mentality where employees keep their heads down. A millennial workforce requires constant support and feedback. (This is not true at all. – Your expectations were if an employee was nice to you, that meant they wanted to do a good job. Due to your belief normal people operate for good, you ignored signs that they were actually insubordinate and willfully not doing their jobs. Due to your need to be liked, you could not hold people accountable when it came to issue a performance review.)

As a part of your candidate screening process include behavioral assessment testing to be used in conjunction with your job descriptions. Looking for “task” oriented personnel can be baked into the process. Investigate the Predictive Index.

When meeting individually with your personnel the focus of the discussion should move from what you can do for them to what is needed from them to do to get things done.
Set expectations, involve personnel in the process, have them report back to you on how things will get done then hold them accountable.

Hire someone that understands your vision and can lead the charge e.g. a Director of Operations (COO).
Reassess the benefits of your industry consultant. Eight years is a long time for the engagement

Being a disciplinarian is not your forte.

Define the following “why we do what we do”, “how we do it”, and “what we do”


  • The recommendations as well as the quarantine provided the time to reassess.
  • I have cleaned house of the toxic people as well as things I was doing that were ineffective
  • I’ve taken my life back and do not live at the office.
  • I pop-in for a few minutes for good reasons and therefore have a much better work-life balance.
  • Of the team members I kept – they are happy and thank me daily
  • Business is up 25% from before COVID.
  • Hired a great new doc based on our VALUES.
  • Renegotiated the office lease
  • Discontinued the services with the industry consultant.

I came up with a solid system at work where profitability is the focus and locked myself out of some to run accounts where they are run automatically with a lot less stress.  As a result, cash account at work is nearly 3 times what it was prior to COVID cash flow is no longer an issue. All credit cards have been paid off.