Medical Decision-Making Skills Can Aid Physician Business Deals

I've spent my career working with physicians around the country, consulting with them daily about the business side of their practices. Through the years, there is always one common theme: "I should have done this sooner!" While the predictability of the comment always makes me laugh, it remains a curiosity. Why do physicians always say this? Why do physicians, arguably some of the most intelligent and highly trained professionals, have such a difficult time pulling the trigger on business decisions?

I was just e-mailing with a physician and heard it again. "I should have done this sooner," he said. I couldn't help but ask what made him hesitate? When presented with a sound, basically risk-free business decision, why the hesitation?

His answer:

"Physicians are almost universally viewed as poor business people. We all know it, we often laugh about it and sometimes we are even preyed upon as a result of it. How many times have we heard stories in the lounge or on the floors about so-and-so who had some disastrous outcome from a business deal? My accountant once told me that just about every doctor he knew had at one point or another in their careers lost money investing in a restaurant. 'You should have just made a charitable donation; it would have been quicker to write off the loss!'

Physicians are as smart if not smarter than most others who have learned to be successful in business so it is funny that they are considered slow at the business end of things. Perhaps because they never took business and economics courses? Perhaps because their business is based on ethics and that blinds them to the needed aggressive characteristics of successful business people? But I don't think so. Physicians are just as aggressive and trained as most successful business people.  

I think it comes down to a split personality when it comes to decision-making."

Many physicians believed that choosing a career in medicine would allow them to divorce themselves from petty business matters. But in today's world, physicians know that is no longer the case. Despite that, they still choose to hand over financial decisions to other "professionals," investment advisors, accountants, and practice managers.

Physicians are taught decision making as an integral component of medical training. They incorporate facts, observations, test results, and physical findings in evolving a differential diagnosis and choose a recommended path based on scaled probability. Sometimes the data set is incomplete so they order more testing or choose time as the great decider. Either way, there is no problem judging information at hand and deciding the necessary path for patients. But, for some reason, physicians view business choices with fear and trepidation, rather than confidence, despite having the intellectual ability to balance facts and probabilities to make an informed choice. If they were to approach medical decision-making in the same way, patients would be harmed.   

In my experience, physicians often focus on the potential downside of business decisions rather than judging the probability of the outcome or its net potential impact. If they applied that reasoning to medicine they'd never order a test or a new drug for a patient. When they see patients focusing on the downside of a treatment plan, they dismiss their fears as irrational. But often, when faced with important medical business decisions that necessitate fundamental change, I find physicians are paralyzed with fear and that inaction is the result despite the deleterious impact of delay. This is not to say that I believe physicians should jump to decisions based on incomplete data, but there just reaches a point where the facts are in, the probabilities are known, and it is decision time. Why hesitate?

When faced with a sound business decision like incorporating a new practice model, especially those that could operate seamlessly alongside their traditional practice, with next to no risk or investment, physicians would be better served to apply their expert medical decision-making skills and decisiveness to medical business decisions and begin reaping the benefits of the new program. 

Applying that kind of decision making could help physicians avoid the old, "I wish I had done this sooner" syndrome.