FROM THE PRESIDENT by Thomas Higgins, MD, MSPH, MBA
The Medical Practice Handbook
There is something special about owning your own practice.
Choosing how many patients to see, deciding the rhythm of your clinic day and hiring people who fit your goals and values: such is the liberating autonomy of independent medical practice.
Imagine two violinists. One is told exactly what to play, every bow stroke prescribed. The other hears the same notes but chooses phrasing, tempo and expression. Both can produce competent music, but the second plays with ownership and soul. Independent practice gives you that second violinist’ s role, allowing you to interpret the score of medicine in ways that align with your tempo and humanity.
Of course, with that creative control comes responsibility. Autonomy without structure can quickly feel like being handed the keys to a car with no map, no headlights and a full tank of confusion. Juggling payroll, scheduling, billing and clinical care can pull at your attention like a dozen small tugboats. The trick is to make the juggling itself more like choreography and less like a circus act. Build the systems that let your preferences be expressed without requiring your constant intervention: reliable scheduling templates that reflect visit complexity, clear staff roles so decisions happen without your constant attention and workflows that streamline your clinical operations.
I have been a rhinologist-otolaryngologist in an independent group practice for over a decade, experiencing both its benefits and challenges. I earned an MBA to gain the skills and knowledge needed to effectively manage and grow the practice, aiming for long-term success and sustainability despite external pressures. This piece is for physicians who value the freedom of independent practice and seek practical ways to keep their businesses running smoothly, so they can focus more on patient care and enjoy quality time with their families. Here are some lessons I have learned over the years.
1. Build a reliable team.
When your practice is small, your team members often wear multiple hats, serving as both administrators and clinical staff. Early on, you will take on much of the administrative responsibility yourself until you are comfortable delegating. As your practice grows, this approach becomes difficult to maintain.
Starting a new medical practice or making significant changes can be daunting. I like to structure the process around a simple but powerful framework:“ I do it. We do it. They do it.” First, I take personal responsibility to model the work and set standards. Then, we collaborate as a team to learn and work together. Finally, tasks are delegated so that others can take full ownership and execute independently with confidence.
You need to ensure that your key team members develop strong managerial skills, including the ability to effectively recruit, interview and select candidates who align with your practice’ s culture and standards. Hiring the right people is foundational because each new team member impacts patient experience, workflow efficiency and overall morale.
You and your administrator( s) need to establish clear, detailed job descriptions that outline specific roles and responsibilities, paired with measurable performance metrics to objectively assess success. And then, implement a structured schedule of regular performance reviews to allow for constructive feedback, recognizing achievements and promptly addressing any performance concerns. I can’ t tell you how often this helps prevent performance issues from going unnoticed until they escalate.
2. If everything is urgent, nothing is strategic.
Running a medical practice can feel like being on a constant treadmill of urgent issues: insurance denials, staffing shortages and last-minute concerns. When every task demands immediate attention, strategic planning falls by the wayside.
While you cannot completely prevent urgent issues, you can eliminate some to allow you to better manage the true emergencies. To regain control, learn to distinguish urgent tasks from important ones. Urgent tasks require immediate action, but may not move your practice forward meaningfully. Important tasks align with your long-term goals, improving patient care quality, optimizing workflows or expanding services, but often lack immediacy.
Empower your team by clearly defining decision-making authority for urgent operational issues. When staff members tackle problems independently within established protocols, fewer issues reach your desk unexpectedly.
Sustainability and growth come from intentional action, not reactive chaos.
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