Collaboration is a cornerstone of a successful practice. When I first started out, the first thing I had to do was find patients. I actively went out and marketed to primary care physicians, physical therapists, orthopedists, and neurosurgeons. I spent my lunch hours in the ambulatory surgery center (ASC) talking and making friends with the other surgeons. I took potential referral sources for lunch, dinner, and golfing. I spent time developing relationships.

One of those relationships was with a neurosurgeon, Dr. Randall Porter, at Barrow Brain and Spine. As we fostered this relationship, he started a co-clinic in our office twice a month—this was over 15 years ago. We would run patients past each other, review imaging together, sometimes examine patients together, and collaboratively treat patients. We would discuss cases with radiologists and other specialists when needed. We developed a comfort with one another and the similarities and differences in our practice.

While professional competence is critical, a physician alone cannot make a practice successful. An individual understanding of the medical practice revenue cycle, accounting, marketing, and team management are essential, but cannot monopolize a clinician’s time and be the preponderance of your daily tasks. The primary task is obviously patient care. A foundational understanding of medicine’s business-side, however, will help you build the right team to handle the bulk of the logistical responsibilities.

I was fortunate enough to find a teammate and ally in Dr. Porter. Over the years, he became one of my best friends and our relationship ultimately helped facilitate the merger of our practices. Collaboration and positive partnerships are vital to success.

Another priority has been patient-centered care. Our focus has always been on delivering high-quality, individualized care to patients, ensuring their needs and preferences are met. One of the things that became very clear when Dr. Porter and I were in clinic together was that we had very similar goals and ways of dealing with patients. We both demonstrated empathy and compassion and would frequently add patients before clinic, during lunch, or after clinic. We both routinely provided our cell phones to referral sources and many patients, and while this may not have always been personally convenient, it made us two of the busiest providers in the group. When referral sources know you will respond to a message and work hard to take care of their patients, they are likely to keep referring.

One challenge in providing such access and service is that it places your staff under some degree of stress. For a practice such as this to be effective, you have to be a good leader and develop a team with flexibility and dedication to patient service. The staff must be willing and able to incorporate patient urgency into their regular workday successfully and efficiently in order to meet this standard of care.

Typically, keeping employees happy is not only about compensation. I think one reason our good employees want to stay is because we have a team-based approach. They see us working harder than anyone else in the practice. I have instilled that our job is to provide the highest level of customer service.

Staff goes through internal training on how to manage difficult patients and how to make everyone happy when they walk through the door. They are friendly, they smile, they make people feel comfortable, and they make them feel confident that the providers on our team can help them feel better. All of this makes my job easier. Everyone knows that the focus is on patient-centered care. When everyone understands the goal, it’s easier to achieve it.

In addition to how we treat patients, we offer comprehensive services, including electrodiagnostic testing, physical therapy, interventional procedures, and surgical options. This holistic approach allows further collaboration between the team when taking care of patients.

The third item is efficient operations. As we grew, it became apparent that we needed to implement effective operational processes, including scheduling, billing, and electronic health records management. This allowed us to streamline practice management and enhance patient experience. One of my friends, a business leader, told me years ago, when hiring, you have options. You need to assess the people you work with. To summarize, he said, ‘There are A-level employees, B-level employees, and C, D, and F-level employees. Your business (practice) will revolve around A-, B-, and C-level employees. Hopefully, you can weed out the D- and F-level employees in the hiring process. If one gets through, make sure there is a probationary period so you can let them go quickly. Time then needs to be spent training C-level employees to be B-level employees and attempting to turn B-level employees into A-level employees. Ultimately, you want your organization full of A- and B-level employees and you need to keep them happy.’

I try to follow this advice. As a result, most of my employees have been with me for many years.

Shortly after becoming a partner in our first practice, I took an interest in billing and collections and developed a basic understanding of the office accounting. After an investigation into the books, it became clear that our office manager, who my partner hired before I got there, was embezzling money from the practice. Additionally, she was not handling the necessary paperwork required for contracting and ensuring timely payment. We terminated her and promoted a front desk employee to assist in the role of office manager. My partner felt strongly about promoting this person to the role because she had been a loyal employee to him for years. In retrospect, this was not the ideal way to hire a person who is critical to practice operations. While trust and loyalty are important, many of the positions in the office require more than that. From that point forward, we recruited leadership to the practice.

The fourth concept is continuous education. I am committed to ongoing training and education for staff and physicians. This means staying updated, not only with the latest advancements in spine care, but also in customer service, revenue cycle, health policy, and practice administration. We hold in-service meetings, team meetings between physicians and revenue cycle staff, and reviews of patient satisfaction surveys.

We also use clinical education sessions as opportunities to educate providers on practice issues. Routine journal clubs with the physiatry providers will have dual functions. For some meetings we will invite billing and collections staff to discuss changes to billing, coding and coverage. In other meetings we will discuss patient care issues and satisfaction.

Another theme is a focus on excellence. Excellence is a habit. Successful people make a habit of doing things others don’t want to do. When you demand the best of yourself for patients, people notice and it sets the standards for others. One of my employees is a nurse that I hired away from the surgery center 17 years ago when we moved the procedure suite in-house. She has watched me train 19 fellows and she feels comfortable sharing experiences.

Once, I overheard her sharing with one of my fellows why she joined our practice. She said, “While the doctor is technically good at what he does, he places an expectation on everyone else in the OR that they will provide the highest level of expertise.” To be clear, I don’t raise my voice at my employees, throw things when I am frustrated, or behave in a manner that would be considered by anyone to be inappropriate. I will teach and train new staff when they join us in the procedure suite. The radiology tech needs to know what I am looking for and why. The MAs need to understand why we ask the questions we do before and after the procedures. The nurse needs to have a clear understanding of what is going on in the case and why.

Leadership is about creating a team where you all can thrive. Through collaboration with those who have the same set of values, you can drive your practice forward. Having a patient-centered operation means everyone focuses their energy in the right way and on doing the right things for patients. Behind the scenes, you must make sure your operations are efficient, and you must continue to educate everyone in a team-based approach.

I feel truly blessed to have the practice I do. I am equally as blessed to have made so many friends and colleagues through my practice, NASS, and the other societies I have been involved with over the last 20-plus years. Thank you, all.